Provider Demographics
NPI:1679758239
Name:ADVANCED WELLNESS AND REHAB, LLC.
Entity type:Organization
Organization Name:ADVANCED WELLNESS AND REHAB, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JON
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-942-5335
Mailing Address - Street 1:2020 N TYLER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4905
Mailing Address - Country:US
Mailing Address - Phone:316-942-5335
Mailing Address - Fax:316-942-5442
Practice Address - Street 1:2020N TYLER RD
Practice Address - Street 2:SUITE 112
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4905
Practice Address - Country:US
Practice Address - Phone:316-942-5335
Practice Address - Fax:316-942-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04547111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660205OtherBC/BS
KS660205OtherBC/BS
KS6082480001Medicare NSC