Provider Demographics
NPI:1275608960
Name:ACTIVE CHIROPRATIC CARE
Entity Type:Organization
Organization Name:ACTIVE CHIROPRATIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELCHERT
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:419-841-9530
Mailing Address - Street 1:3020 N MCCORD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1702
Mailing Address - Country:US
Mailing Address - Phone:419-841-9530
Mailing Address - Fax:419-841-9537
Practice Address - Street 1:3020 N MCCORD RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1702
Practice Address - Country:US
Practice Address - Phone:419-841-9530
Practice Address - Fax:419-841-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC 3007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2195931Medicaid
OH000000222583OtherANTHEM
OH2195931Medicaid