Healthcare Provider Details

I. General information

NPI: 1215033311
Provider Name (Legal Business Name): ADVANCED SPINE AND HEADACHE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21751 W 11 MILE RD SUITE 110
SOUTHFIELD MI
48076-3712
US

IV. Provider business mailing address

21751 W 11 MILE RD SUITE 110
SOUTHFIELD MI
48076-3712
US

V. Phone/Fax

Practice location:
  • Phone: 248-356-2100
  • Fax: 248-356-2121
Mailing address:
  • Phone: 248-356-2100
  • Fax: 248-356-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEX MELTSER
Title or Position: OWNER
Credential: D.C.
Phone: 248-356-2100