Provider Demographics
NPI:1730716408
Name:ATTIVO WELLNESS LLC
Entity type:Organization
Organization Name:ATTIVO WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-212-7006
Mailing Address - Street 1:1550 W HORIZON RIDGE PKWY # R612
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3600
Mailing Address - Country:US
Mailing Address - Phone:310-212-7006
Mailing Address - Fax:310-212-7006
Practice Address - Street 1:1550 W HORIZON RIDGE PKWY # R612
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3600
Practice Address - Country:US
Practice Address - Phone:310-212-7006
Practice Address - Fax:310-212-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty