Provider Demographics
NPI:1598046195
Name:ACTIVE HEALTH
Entity Type:Organization
Organization Name:ACTIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NEUFANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-893-2400
Mailing Address - Street 1:11011 S 48TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1779
Mailing Address - Country:US
Mailing Address - Phone:480-893-2400
Mailing Address - Fax:480-893-2412
Practice Address - Street 1:11011 S 48TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1779
Practice Address - Country:US
Practice Address - Phone:480-893-2400
Practice Address - Fax:480-893-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7283111N00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ149673Medicare PIN
AZZ149674Medicare PIN