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General NPI Number Information
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NPI Number | 1104302793
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Entity Type | Organization
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Legal Business Name | ADVANCE CHIROPRACTIC CENTER PLLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 2840 19TH AVE S
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City | GRAND FORKS
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State | ND
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Zip | 58201-5957
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Country | US
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Telephone | 701-772-2670
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Fax | 701-772-2706
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Provider Business Mailing Address
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Address Line | 2840 19TH AVE S
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City | GRAND FORKS
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State | ND
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Zip | 58201-5957
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Country | US
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Telephone | 701-772-2670
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Fax | 701-772-2706
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JULIE ANN HANSON
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Credential |
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Telephone | 701-772-2670
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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 |
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License Number State |
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