Organization · NPI-2

Active Wellness LLC

Chiropractor · Chicago, IL

NPI number1427483791
StatusActive
Last updated in NPPESSep 5, 2013

Details

NPI
1427483791
Entity type
Organization (NPI-2)
Legal business name
Active Wellness LLC
Organization subpart
No
Enumeration date
Sep 5, 2013
Last updated
Sep 5, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
111N00000X Chiropractor––Yes
111NN1001X Chiropractor, Nutrition––
111NP0017X Chiropractor, Pediatric Chiropractor––
111NS0005X Chiropractor, Sports Physician––
171100000X Acupuncturist––

Practice location

3514 N Southport Ave
Chicago, IL 60657-1436

Phone 773-598-4387

Mailing address

4555 N Lincoln Ave
Chicago, IL 60625-2102

Phone 773-328-8153

Authorized official

Andrew Ingley
Manager
8132209113

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