Healthcare Provider Details

I. General information

NPI: 1245415546
Provider Name (Legal Business Name): ADVANCED CHIROPRACTIC CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 RANCHEROS DR STE 190
SAN MARCOS CA
92069-2900
US

IV. Provider business mailing address

340 RANCHEROS DR STE 190
SAN MARCOS CA
92069-2900
US

V. Phone/Fax

Practice location:
  • Phone: 760-744-2744
  • Fax: 760-744-2798
Mailing address:
  • Phone: 760-744-2744
  • Fax: 760-744-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25170
License Number StateCA

VIII. Authorized Official

Name: MS. FELICIA THOMAS
Title or Position: OWNER BILLING SERVICE
Credential:
Phone: 858-504-0595