Provider Demographics
NPI:1710253844
Name:ACTIVE CARE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:ACTIVE CARE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-598-3458
Mailing Address - Street 1:6800 PITTSFORD PALMYRA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3514
Mailing Address - Country:US
Mailing Address - Phone:585-598-3458
Mailing Address - Fax:585-598-3459
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD
Practice Address - Street 2:SUITE 420
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3584
Practice Address - Country:US
Practice Address - Phone:585-598-3458
Practice Address - Fax:585-598-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0010870111NS0005X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY666475OtherACN
7096545OtherAETNA