Healthcare Provider Details

I. General information

NPI: 1417577982
Provider Name (Legal Business Name): ADVANCED HEALTH CHIROPRACTIC CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 SHALLOWFORD RD STE 100
CHATTANOOGA TN
37421-1972
US

IV. Provider business mailing address

6221 SHALLOWFORD RD STE 100
CHATTANOOGA TN
37421-1972
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-2053
  • Fax:
Mailing address:
  • Phone: 423-648-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COLEEN CARBERRY
Title or Position: MANAGER
Credential:
Phone: 423-362-4142