Provider Demographics
NPI:1740237429
Name:ACTIVE LIFE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ACTIVE LIFE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANIENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-463-8881
Mailing Address - Street 1:54 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2606
Mailing Address - Country:US
Mailing Address - Phone:978-463-8881
Mailing Address - Fax:978-463-4411
Practice Address - Street 1:54 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2606
Practice Address - Country:US
Practice Address - Phone:978-463-8881
Practice Address - Fax:978-463-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty