CMS-1500 Box 24J / 33a • NPI
1255647996
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
111NS0005X (CMS 35)
Licensed & Credentialed Chiropractic Providers — Chiropractor, Sports Physician
Box 32 Service Location & ZIP+4
755 BOARDMAN CANFIELD RD STE P1, BOARDMAN, OH, 44512-7325
✓ 9-Digit EDI 837 ZIP+4 (44512-7325)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1255647996 (ADVANCED CHIROPRACTIC AND PHYSICAL THERAPY LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1255647996 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ADVANCED CHIROPRACTIC AND PHYSICAL THERAPY LLC |
| Plain-English Specialty | Licensed & Credentialed Chiropractic Providers — Chiropractor, Sports Physician NUCC Code: 111NS0005X (Chiropractor, Sports Physician) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 755 BOARDMAN CANFIELD RD STE P1, BOARDMAN, OH, 44512-7325 |
| Practice Telephone / Fax | Tel: (330) 726-7404 | Fax: (330) 729-9166 |
| Administrative Mailing Address | PO BOX 3351, BOARDMAN, OH, 44513-3351 |
| Enumeration & Last Sync | Enumerated: 2010-08-19 | CMS Record Updated: 2017-04-17 |
| Authorized Official | MICHAEL LYONS (MEMBER) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (111NS0005X)
What Does Taxonomy Code 111NS0005X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 111NS0005X translates to:
"Licensed & Credentialed Chiropractic Providers — Chiropractor, Sports Physician"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ADVANCED CHIROPRACTIC AND PHYSICAL THERAPY LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
111NR0400X — Chiropractor, RehabilitationPlain English: Licensed & Credentialed Chiropractic Providers — Chiropractor, Rehabilitation | State: OH | License: 2826 | Primary: Secondary |
224Y00000X — Clinical Exercise PhysiologistPlain English: Licensed & Credentialed Clinical Exercise Physiologist | State: N/A | License: Verified | Primary: Secondary |
225100000X — Physical TherapistPlain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist | State: N/A | License: Verified | Primary: Secondary |
225200000X — Physical Therapy AssistantPlain English: Licensed & Credentialed Physical Therapy Assistant | State: N/A | License: Verified | Primary: Secondary |
225700000X — Massage TherapistPlain English: Licensed & Credentialed Massage Therapist | State: N/A | License: Verified | Primary: Secondary |
111NS0005X — Chiropractor, Sports PhysicianPlain English: Licensed & Credentialed Chiropractic Providers — Chiropractor, Sports Physician | State: OH | License: 2826 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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