MEDICARE: ADVANTAGE RADIOLOGY SERVICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor	DC1897	OH

General Provider Information

NPI Number	:	1386024651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE RADIOLOGY SERVICE LLC

Provider Business Mailing Address
First Line	:	723 PHILLIPS AVE
Second Line	:	SUITE 275
City	:	TOLEDO
State	:	OH
Zip	:	43612-1300
Country	:	US
Telephone Number	:	419-269-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	723 PHILLIPS AVE
Second Line	:	SUITE 275
City	:	TOLEDO
State	:	OH
Zip	:	43612-1300
Country	:	US
Telephone Number	:	419-269-2424
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CRAIG P CHURCH
Credential	:	DC
Telephone Number	:	419-269-2424

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	07/07/2015

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