Provider Demographics
NPI:1164936514
Name:ACTIVE CHIROPRACTIC SERVICES, P.C
Entity Type:Organization
Organization Name:ACTIVE CHIROPRACTIC SERVICES, P.C
Other - Org Name:ACTIVE CHIROPRACTIC OF RYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-409-8385
Mailing Address - Street 1:31 PURCHASE ST STE 2-2
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3013
Mailing Address - Country:US
Mailing Address - Phone:914-409-8385
Mailing Address - Fax:
Practice Address - Street 1:31 PURCHASE ST STE 2-2
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3013
Practice Address - Country:US
Practice Address - Phone:914-409-8385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012102-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty