Provider Demographics
NPI:1851553176
Name:ACTIVE HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:ACTIVE HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-622-9355
Mailing Address - Street 1:PO BOX 956093
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9502
Mailing Address - Country:US
Mailing Address - Phone:770-622-9355
Mailing Address - Fax:
Practice Address - Street 1:3780 OLD NORCROSS RD
Practice Address - Street 2:SUITE 301B
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1740
Practice Address - Country:US
Practice Address - Phone:770-622-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty