Provider Demographics
NPI:1538452859
Name:ACTIVE HEALTH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ACTIVE HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KMIEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-558-2225
Mailing Address - Street 1:371 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2005
Mailing Address - Country:US
Mailing Address - Phone:570-558-2225
Mailing Address - Fax:570-558-6325
Practice Address - Street 1:371 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2005
Practice Address - Country:US
Practice Address - Phone:570-558-2225
Practice Address - Fax:570-558-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008926261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center