Provider Demographics
NPI:1104199983
Name:ACTIVE HEALTH LTD
Entity Type:Organization
Organization Name:ACTIVE HEALTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PANOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-739-3120
Mailing Address - Street 1:PO BOX 2308
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60138-2308
Mailing Address - Country:US
Mailing Address - Phone:847-739-3120
Mailing Address - Fax:
Practice Address - Street 1:1550 N NORTHWEST HWY STE 206
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1459
Practice Address - Country:US
Practice Address - Phone:847-739-3120
Practice Address - Fax:847-886-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.9079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U86150Medicare UPIN