# ADVANCED BACK & WELLNESS CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538571955
- **Authorized official:** DR. DEBRA ANN BURNS DC (CHIROPRACTIC PHYSICIAN)
- **Authorized official phone:** (860) 928-2292

## Contact information

- **Practice address:** 21 S MAIN ST, PUTNAM, CT 06260-1906
- **Practice address phone:** (860) 928-2292
- **Practice address fax:** (860) 928-0537
- **Mailing address:** 21 S MAIN ST, PUTNAM, CT 06260-1906
- **Mailing address phone:** (860) 928-2292
- **Mailing address fax:** (860) 928-0537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | Yes |
| 111N00000X | Chiropractor | — | — | Yes |

## Other

- **Enumeration date:** 05/21/2014
- **Last updated:** 07/15/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | D100146044 | MEDICARE GROUP PTAN | CT |