Organization
ACTIVE LIFE & SPORTS CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRANK W FRYDRYCH JR. D.C. (OWNER)
(630) 519-6284
Entity
Organization
Contact information
Practice address
929 S MAIN ST, UNIT 107A, LOMBARD, IL 60148-3325
(630) 519-6284
(866) 443-0749
Mailing address
929 S MAIN ST, UNIT 107A, LOMBARD, IL 60148
(630) 519-6284
(866) 443-0749
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038011082
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R00055
MEDICARE PTAN
IL
Enumeration date
02/12/2016
Last updated
02/12/2016
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