Provider Demographics
NPI:1780880336
Name:ADVANCED DISC AND SPINE HEALTH, LLC
Entity type:Organization
Organization Name:ADVANCED DISC AND SPINE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:JEFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-318-1632
Mailing Address - Street 1:1470 SW KNOLL AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3186
Mailing Address - Country:US
Mailing Address - Phone:541-318-1632
Mailing Address - Fax:541-312-3198
Practice Address - Street 1:1470 SW KNOLL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3186
Practice Address - Country:US
Practice Address - Phone:541-318-1632
Practice Address - Fax:541-312-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty