Provider Demographics
NPI:1336395771
Name:ACTIVE HEALTH CONCEPTS
Entity Type:Organization
Organization Name:ACTIVE HEALTH CONCEPTS
Other - Org Name:ACTIVE HEALTH CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-218-8106
Mailing Address - Street 1:1601 237TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1324
Mailing Address - Country:US
Mailing Address - Phone:310-218-8106
Mailing Address - Fax:310-325-6138
Practice Address - Street 1:1601 237TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-1324
Practice Address - Country:US
Practice Address - Phone:310-218-8106
Practice Address - Fax:310-325-6138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE HEALTH CONCEPTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28271111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740383363Medicare PIN