Provider Demographics
NPI:1184927220
Name:ACTIVE CHIROPRACTIC
Entity type:Organization
Organization Name:ACTIVE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:DIONNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-362-2207
Mailing Address - Street 1:1250 WILSON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4454
Mailing Address - Country:US
Mailing Address - Phone:906-225-0597
Mailing Address - Fax:906-225-9281
Practice Address - Street 1:1983 NORWOOD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-1435
Practice Address - Country:US
Practice Address - Phone:906-225-0597
Practice Address - Fax:906-225-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty