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General NPI Number Information
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NPI Number | 1073761532
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Entity Type | Organization
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Legal Business Name | ADVANCED ALTERNATIVE SPINAL CARE
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 417 N MAIN ST
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City | BONHAM
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State | TX
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Zip | 75418-4322
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Country | US
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Telephone | 903-583-7411
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Fax | 903-583-9601
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Provider Business Mailing Address
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Address Line | 417 N MAIN ST
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City | BONHAM
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State | TX
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Zip | 75418-4322
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Country | US
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Telephone | 903-583-7411
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Fax | 903-583-9601
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN E EGSTAD
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Credential | DC
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Telephone | 903-583-7411
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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 | 5252
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License Number State | TX
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