Provider Demographics
NPI:1548447063
Name:ADVANCED CLINIC CHIROPRACTIC
Entity type:Organization
Organization Name:ADVANCED CLINIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-280-4629
Mailing Address - Street 1:7211 PLAZA CTR DR #120
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-4317
Mailing Address - Country:US
Mailing Address - Phone:801-280-4629
Mailing Address - Fax:801-280-8495
Practice Address - Street 1:7211 PLAZA CTR DR #120
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-4317
Practice Address - Country:US
Practice Address - Phone:801-280-4629
Practice Address - Fax:801-280-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175690-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty