Provider Demographics
NPI:1629180302
Name:ACTIVE CARE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ACTIVE CARE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ALLMANDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-787-2288
Mailing Address - Street 1:1001 LAURENCE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2980
Mailing Address - Country:US
Mailing Address - Phone:517-787-2288
Mailing Address - Fax:517-787-2288
Practice Address - Street 1:1001 LAURENCE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2980
Practice Address - Country:US
Practice Address - Phone:517-787-2288
Practice Address - Fax:517-787-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P03160Medicare PIN