Organization
ACTIVE LIFE CHIROPRACTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY B RIEDEL D.O. (OWNER)
(440) 466-1155
Entity
Organization
Contact information
Practice address
614 E MAIN ST, GENEVA, OH 44041-1385
(440) 466-1155
(440) 466-1255
Mailing address
614 E MAIN ST, GENEVA, OH 44041-1385
(440) 466-1155
(440) 466-1255
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3328
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PO0199838
RAILROAD MEDICARE
OH
Enumeration date
07/17/2006
Last updated
06/16/2008
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