Healthcare Provider Details

I. General information

NPI: 1386785293
Provider Name (Legal Business Name): ADVANCED SPINE AND REHAB CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 GLASS RD NE
CEDAR RAPIDS IA
52402-2514
US

IV. Provider business mailing address

4205 GLASS RD NE
CEDAR RAPIDS IA
52402-2514
US

V. Phone/Fax

Practice location:
  • Phone: 319-294-0094
  • Fax: 319-294-0095
Mailing address:
  • Phone: 319-294-0094
  • Fax: 319-294-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110073
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6916
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27216
License Number StateIA

VIII. Authorized Official

Name: DR. JEFFREY ALAN MITCHELL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 319-981-2292