Organization · NPI-2

Active Chiropractic Wellness Center, LLC

Chiropractor · Jacksonville, FL

NPI number1982850830
StatusActive
Last updated in NPPESDec 16, 2019

Details

NPI
1982850830
Entity type
Organization (NPI-2)
Legal business name
Active Chiropractic Wellness Center, LLC
Organization subpart
No
Enumeration date
Aug 12, 2008
Certification date
Dec 16, 2019
Last updated
Dec 16, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
111N00000X ChiropractorCH7715FLYes

Practice location

2570 Atlantic Blvd
Jacksonville, FL 32207-3604

Phone 904-398-4860 · Fax 904-398-1785

Mailing address

2570 Atlantic Blvd
Jacksonville, FL 32207-3604

Phone 904-226-9110 · Fax 904-398-1785

Authorized official

Christopher Brian Renne
Owner
9043984860

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