Provider Demographics
NPI:1851629570
Name:ACTIVE FAMILY HEALTH CLINIC
Entity Type:Organization
Organization Name:ACTIVE FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-244-9828
Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4245
Mailing Address - Country:US
Mailing Address - Phone:330-244-9828
Mailing Address - Fax:330-244-9829
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4245
Practice Address - Country:US
Practice Address - Phone:330-244-9828
Practice Address - Fax:330-244-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty