MEDICARE: ADVANCED CARE CHIROPRACTIC CENTER

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	111N00000X	Chiropractor	DC31317	CA

General Provider Information

NPI Number	:	1851783682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CARE CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	1613 S RIVERSIDE AVE
Second Line	:	STE. D
City	:	RIALTO
State	:	CA
Zip	:	92376-7701
Country	:	US
Telephone Number	:	909-820-2220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 S RIVERSIDE AVE
Second Line	:	STE. D
City	:	RIALTO
State	:	CA
Zip	:	92376-7701
Country	:	US
Telephone Number	:	909-820-2220
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THY KHANH NGUYEN
Credential	:	D.C.
Telephone Number	:	909-820-2220

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	03/03/2015

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