Provider Demographics
NPI:1467672121
Name:ACTIVHEALTH CHIROPRACTIC, P.L.L.C
Entity Type:Organization
Organization Name:ACTIVHEALTH CHIROPRACTIC, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BARE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-673-7400
Mailing Address - Street 1:20A NORTHWEST BLVD
Mailing Address - Street 2:267
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-4066
Mailing Address - Country:US
Mailing Address - Phone:603-673-7400
Mailing Address - Fax:
Practice Address - Street 1:76 STATE ROUTE 101A
Practice Address - Street 2:SUITE 7
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2258
Practice Address - Country:US
Practice Address - Phone:603-673-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6210101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty