Provider Demographics
NPI:1093028623
Name:ACTIVE COMMUNITY CHIROPRACTIC, L.L.C.
Entity Type:Organization
Organization Name:ACTIVE COMMUNITY CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-628-9925
Mailing Address - Street 1:1695 TERRELL RIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6017
Mailing Address - Country:US
Mailing Address - Phone:678-628-9925
Mailing Address - Fax:
Practice Address - Street 1:5975 ROSWELL RD NE
Practice Address - Street 2:SUITE A-109
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4048
Practice Address - Country:US
Practice Address - Phone:678-628-9925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008692261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center