Provider Demographics
NPI:1528230620
Name:ACTIVE HEALTHCARE,P.C.
Entity Type:Organization
Organization Name:ACTIVE HEALTHCARE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PASTERNACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-869-3847
Mailing Address - Street 1:101-1 HIGHLANDER RD
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2916
Mailing Address - Country:US
Mailing Address - Phone:540-869-3847
Mailing Address - Fax:540-869-3979
Practice Address - Street 1:1010 EICHELBERGER ST
Practice Address - Street 2:SUITE 9
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1374
Practice Address - Country:US
Practice Address - Phone:540-869-3847
Practice Address - Fax:540-869-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty