Provider Demographics
NPI:1972728467
Name:ACTIVE CARE CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:ACTIVE CARE CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PILAR
Authorized Official - Middle Name:MINETT
Authorized Official - Last Name:WILLIAMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-989-1805
Mailing Address - Street 1:2821 N BALLAS RD
Mailing Address - Street 2:SUITE C 55
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2321
Mailing Address - Country:US
Mailing Address - Phone:314-989-1805
Mailing Address - Fax:314-989-1836
Practice Address - Street 1:2821 N BALLAS RD
Practice Address - Street 2:SUITE C 55
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2321
Practice Address - Country:US
Practice Address - Phone:314-989-1805
Practice Address - Fax:314-989-1836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty