# ACTIVE SPINE CHIROPRACTIC, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932577160
- **Authorized official:** DR. JAY WITTGREEN D.C. (CEO / OWNER)
- **Authorized official phone:** (786) 759-6265

## Contact information

- **Practice address:** 1255 N FLAGLER DR, FORT LAUDERDALE, FL 33304-2131
- **Practice address phone:** (786) 759-6265
- **Mailing address:** 2421 NE 65TH ST, 307, FORT LAUDERDALE, FL 33308-1556
- **Mailing address phone:** (786) 759-6265

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | CH10100 | FL | Yes |

## Other

- **Enumeration date:** 09/03/2015
- **Last updated:** 09/03/2015