Provider Demographics
NPI:1164642765
Name:ACTIVE HEALTH SERVICES
Entity Type:Organization
Organization Name:ACTIVE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FLEMING
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:214-220-3177
Mailing Address - Street 1:PO BOX 1844
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75221-1844
Mailing Address - Country:US
Mailing Address - Phone:214-220-9177
Mailing Address - Fax:214-220-0410
Practice Address - Street 1:1717 MAIN ST STE 5640
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7348
Practice Address - Country:US
Practice Address - Phone:241-220-9117
Practice Address - Fax:214-220-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6026OtherLICENSE
=========OtherTAX ID
U37606Medicare UPIN