NPI 1891120408 · live from the CMS NPI Registry
Active Wellness LLC
Chiropractor in Chicago, IL. National Provider Identifier 1891120408, active.
NPI record
| NPI | 1891120408 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Chiropractor 111N00000X |
| Practice location | 560 W Diversey Pkwy, Chicago, IL 60614 |
| Practice phone | 773-524-6830 |
| Mailing address | 4555 N Lincoln Ave, Chicago, IL 60625 |
| Enumerated | September 13, 2013 |
| Last updated | October 2, 2013 |
| Authorized official | Andrew Ingley, Manager |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Chiropractor, Nutrition | 111NN1001X | — |
| Chiropractor, Pediatric Chiropractor | 111NP0017X | — |
| Chiropractor, Sports Physician | 111NS0005X | — |
| Acupuncturist | 171100000X | — |
| Chiropractor primary | 111N00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.