Provider Demographics
NPI:1255437604
Name:ADVANCED FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:ADVANCED FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:PIERSOL
Authorized Official - Suffix:
Authorized Official - Credentials:DC DACRB
Authorized Official - Phone:740-374-3232
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0965
Mailing Address - Country:US
Mailing Address - Phone:740-374-3232
Mailing Address - Fax:740-374-3436
Practice Address - Street 1:326 3RD STREET
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750
Practice Address - Country:US
Practice Address - Phone:740-374-3232
Practice Address - Fax:740-374-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006157Medicaid
OH0690793Medicaid
WV3810006157Medicaid