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General NPI Number Information
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NPI Number | 1265938500
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Entity Type | Organization
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Legal Business Name | ADVANCED SPINE AND JOINT PLLC
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 7209 CREEDMOOR RD STE 107
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City | RALEIGH
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State | NC
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Zip | 27613-1695
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Country | US
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Telephone | 919-390-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 7209 CREEDMOOR RD STE 107
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City | RALEIGH
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State | NC
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Zip | 27613-1695
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Country | US
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Telephone | 919-390-2444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN GRAHAM CLEMENTS
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Credential | DC
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Telephone | 919-390-2444
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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 | 4588
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License Number State | NC
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