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General NPI Number Information
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NPI Number | 1336497643
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Entity Type | Organization
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Legal Business Name | ADVANCED TECHNOLOGY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 4494 W PEORIA AVE STE 116
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City | GLENDALE
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State | AZ
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Zip | 85302-2025
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Country | US
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Telephone | 623-842-1261
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Fax |
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Provider Business Mailing Address
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Address Line | 4494 W PEORIA AVE STE 116
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City | GLENDALE
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State | AZ
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Zip | 85302-2025
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Country | US
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Telephone | 623-842-1261
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | BRUCE SCHMIDT
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Credential | DC
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Telephone | 623-842-1261
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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 | AZ
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