Provider Demographics
NPI:1386814309
Name:ACTIVE RECOVERY BOSTON, LLC
Entity Type:Organization
Organization Name:ACTIVE RECOVERY BOSTON, LLC
Other - Org Name:ACTIVE RECOVERY BOSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-835-0475
Mailing Address - Street 1:391 E. CENTRAL ST
Mailing Address - Street 2:#1
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038
Mailing Address - Country:US
Mailing Address - Phone:617-273-2552
Mailing Address - Fax:617-273-2552
Practice Address - Street 1:391 E. CENTRAL ST
Practice Address - Street 2:#1
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038
Practice Address - Country:US
Practice Address - Phone:617-423-3370
Practice Address - Fax:617-423-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45773Medicare UPIN