Provider Demographics
NPI:1679173470
Name:ADVANTAGE CHIROPRACTIC & ACUPUNCTURE LLC
Entity type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC & ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:BOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-641-6804
Mailing Address - Street 1:40190 COUNTY ROAD 17
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:NE
Mailing Address - Zip Code:69357-3926
Mailing Address - Country:US
Mailing Address - Phone:308-641-6804
Mailing Address - Fax:
Practice Address - Street 1:1930 E 20TH PL STE 200E
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-2874
Practice Address - Country:US
Practice Address - Phone:308-641-6804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026847300Medicaid