Provider Demographics
NPI:1376800516
Name:ACTIVE HEALTH CHIROPRACTIC SP PLLC
Entity Type:Organization
Organization Name:ACTIVE HEALTH CHIROPRACTIC SP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-227-7491
Mailing Address - Street 1:1019 S GRAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-5722
Mailing Address - Country:US
Mailing Address - Phone:515-227-7491
Mailing Address - Fax:888-594-7231
Practice Address - Street 1:1019 S GRAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-5722
Practice Address - Country:US
Practice Address - Phone:515-227-7491
Practice Address - Fax:888-594-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty