Provider Demographics
NPI:1538592159
Name:ADVANCED FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:ADVANCED FAMILY CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:GRAMMER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:801-471-0670
Mailing Address - Street 1:155 S STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2031
Mailing Address - Country:US
Mailing Address - Phone:801-471-0670
Mailing Address - Fax:801-471-0719
Practice Address - Street 1:155 S STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2031
Practice Address - Country:US
Practice Address - Phone:801-471-0670
Practice Address - Fax:801-471-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2804381202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty