Provider Demographics
NPI:1487754842
Name:ADVANTAGE CHIROPRACTIC CENTER P.A.
Entity type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC CENTER P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-251-1080
Mailing Address - Street 1:32 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-6392
Mailing Address - Country:US
Mailing Address - Phone:320-251-1080
Mailing Address - Fax:320-656-8991
Practice Address - Street 1:32 32ND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-6392
Practice Address - Country:US
Practice Address - Phone:320-251-1080
Practice Address - Fax:320-656-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN689215900Medicaid