Provider Demographics
NPI:1235462565
Name:ACTIVE HEALTH CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ACTIVE HEALTH CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BS
Authorized Official - Phone:309-246-4305
Mailing Address - Street 1:331 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LACON
Mailing Address - State:IL
Mailing Address - Zip Code:61540-1209
Mailing Address - Country:US
Mailing Address - Phone:309-246-4305
Mailing Address - Fax:
Practice Address - Street 1:331 5TH ST
Practice Address - Street 2:
Practice Address - City:LACON
Practice Address - State:IL
Practice Address - Zip Code:61540-1209
Practice Address - Country:US
Practice Address - Phone:309-246-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209741Medicare UPIN