Provider Demographics
NPI:1346469517
Name:ACTIVELIFE FAMILY CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:ACTIVELIFE FAMILY CHIROPRACTIC & WELLNESS
Other - Org Name:ACTIVELIFE FAMILY CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:DILLARD
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-438-7000
Mailing Address - Street 1:307 GRAND ISLAND DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1299
Mailing Address - Country:US
Mailing Address - Phone:229-438-7000
Mailing Address - Fax:229-438-7200
Practice Address - Street 1:307 GRAND ISLAND DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1299
Practice Address - Country:US
Practice Address - Phone:229-438-7000
Practice Address - Fax:229-438-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR0006583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty