Organization · NPI-2
Active Wellness LLC
Chiropractor · Chicago, IL
NPI number1447685052
StatusActive
Last updated in NPPESOct 8, 2013
Details
- NPI
- 1447685052
- Entity type
- Organization (NPI-2)
- Legal business name
- Active Wellness LLC
- Organization subpart
- No
- Enumeration date
- Sep 13, 2013
- Last updated
- Oct 8, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | – | – | Yes |
| 111NN1001X | Chiropractor, Nutrition | – | – | |
| 111NP0017X | Chiropractor, Pediatric Chiropractor | – | – | |
| 111NS0005X | Chiropractor, Sports Physician | – | – | |
| 171100000X | Acupuncturist | – | – |
Practice location
338 E OhioChicago, IL 60611
Phone 773-328-8153 · Fax 773-273-6736
Mailing address
4555 N Lincoln AveChicago, IL 60625-2102
Phone 773-328-8153
Authorized official
Andrew Ingley
Manager
8132209113
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