Healthcare Provider Details

I. General information

NPI: 1124396718
Provider Name (Legal Business Name): ADVANCED HEALTHCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 S SHIELDS ST STE 2H
FORT COLLINS CO
80526-1857
US

IV. Provider business mailing address

2531 S SHIELDS ST STE 2H
FORT COLLINS CO
80526-1857
US

V. Phone/Fax

Practice location:
  • Phone: 970-472-8333
  • Fax: 970-472-8332
Mailing address:
  • Phone: 970-472-8333
  • Fax: 970-472-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5759
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49380
License Number StateCO

VIII. Authorized Official

Name: DR. NATHAN M IRWIN
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 970-222-7327