Provider Demographics
NPI:1689905747
Name:ACTIVE BODY CHIRO CARE
Entity Type:Organization
Organization Name:ACTIVE BODY CHIRO CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-699-9299
Mailing Address - Street 1:5400 W ROSECRANS AVE
Mailing Address - Street 2:WITHIN EQUINOX
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6682
Mailing Address - Country:US
Mailing Address - Phone:310-699-9299
Mailing Address - Fax:310-297-9393
Practice Address - Street 1:5400 W ROSECRANS AVE
Practice Address - Street 2:WITHIN EQUINOX
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6682
Practice Address - Country:US
Practice Address - Phone:310-699-9299
Practice Address - Fax:310-297-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty