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General NPI Number Information
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NPI Number | 1861737926
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Entity Type | Organization
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Legal Business Name | ADVANCED HEALTH AND WELLNESS CENTER OF OHIO LLC
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Dates
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Enumeration Date | 11/30/2012
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 8930 BRECKSVILLE RD
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City | BRECKSVILLE
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State | OH
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Zip | 44141-2318
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Country | US
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Telephone | 440-740-0696
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Fax | 440-740-0697
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Provider Business Mailing Address
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Address Line | 8930 BRECKSVILLE RD
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City | BRECKSVILLE
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State | OH
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Zip | 44141-2318
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Country | US
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Telephone | 440-740-0696
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Fax | 440-740-0697
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADAM MACK
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Credential | DC
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Telephone | 440-740-0696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35082293
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License Number State | OH
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