Provider Demographics
NPI:1730483991
Name:ACTIVE CHIROPRACTIC
Entity Type:Organization
Organization Name:ACTIVE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-464-7700
Mailing Address - Street 1:1916 WELSH RD
Mailing Address - Street 2:6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4655
Mailing Address - Country:US
Mailing Address - Phone:215-464-7700
Mailing Address - Fax:215-464-7703
Practice Address - Street 1:1916 WELSH RD
Practice Address - Street 2:6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4655
Practice Address - Country:US
Practice Address - Phone:215-464-7700
Practice Address - Fax:215-464-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-004073L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty