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General NPI Number Information
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NPI Number | 1063785418
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Entity Type | Organization
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Legal Business Name | ADVANCED HEALTHCARE PLLC
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 5209 W 65TH ST
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City | LITTLE ROCK
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State | AR
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Zip | 72209-3817
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Country | US
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Telephone | 870-534-8212
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Fax | 870-534-8216
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Provider Business Mailing Address
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Address Line | 5209 W 65TH ST
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City | LITTLE ROCK
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State | AR
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Zip | 72209-3817
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Country | US
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Telephone | 870-534-8212
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Fax | 870-534-8216
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Authorized Official
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Title or Position | MEMBER
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Name | DR. GLEN BROWN JR.
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Credential | D.C.
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Telephone | 870-534-8212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1684
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1664
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License Number State | AR
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