Healthcare Provider Details

I. General information

NPI: 1184209223
Provider Name (Legal Business Name): ADVANTAGE CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 KELLY RD STE 102
APEX NC
27502-9515
US

IV. Provider business mailing address

JARED SURBAUGH 2105 AMALFI PL.
APEX NC
27502
US

V. Phone/Fax

Practice location:
  • Phone: 304-627-5435
  • Fax: 910-399-7651
Mailing address:
  • Phone: 304-627-5435
  • Fax: 910-399-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JARED KYLE SURBAUGH
Title or Position: OWNER
Credential: DC
Phone: 304-627-5435