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Organization
ACTIVE WELLNESS LLC
Active
Organization
ACTIVE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW INGLEY (MANAGER)
(813) 220-9113
Entity
Organization
Contact information
Practice address
3514 N SOUTHPORT AVE, CHICAGO, IL 60657-1436
(773) 598-4387
Mailing address
4555 N LINCOLN AVE, CHICAGO, IL 60625-2102
(773) 328-8153
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
111NN1001X
Nutrition Chiropractor
—
—
111NP0017X
Pediatric Chiropractor
—
—
111NS0005X
Sports Physician Chiropractor
—
—
171100000X
Acupuncturist
—
—
Other
Enumeration date
09/05/2013
Last updated
09/05/2013
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