Provider Demographics
NPI:1144559675
Name:ADVANCED CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ABOUDIB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-421-5213
Mailing Address - Street 1:3337 S AIRPORT RD W STE 2
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7927
Mailing Address - Country:US
Mailing Address - Phone:231-421-5213
Mailing Address - Fax:231-421-5215
Practice Address - Street 1:3337 S AIRPORT RD W STE 2
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7927
Practice Address - Country:US
Practice Address - Phone:231-421-5213
Practice Address - Fax:231-421-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty