Provider Demographics
NPI:1023278710
Name:ADVANCED HEALTH REHAB
Entity type:Organization
Organization Name:ADVANCED HEALTH REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-226-3563
Mailing Address - Street 1:PO BOX 273285
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-3285
Mailing Address - Country:US
Mailing Address - Phone:970-226-3563
Mailing Address - Fax:
Practice Address - Street 1:601 E SWALLOW RD
Practice Address - Street 2:B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2274
Practice Address - Country:US
Practice Address - Phone:970-226-3563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty