Provider Demographics
NPI:1881880722
Name:ACTIVE HEALTH & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ACTIVE HEALTH & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:OREFICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-283-5404
Mailing Address - Street 1:255 CHERRY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3503
Mailing Address - Country:US
Mailing Address - Phone:203-283-5404
Mailing Address - Fax:203-283-5405
Practice Address - Street 1:255 CHERRY ST
Practice Address - Street 2:SUITE A
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3503
Practice Address - Country:US
Practice Address - Phone:203-283-5404
Practice Address - Fax:203-283-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty