Organization
ACTIVE LIFE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MARK PRATOR JR. D.C. (INSTITUTE DIRECTOR)
(630) 717-8575
Entity
Organization
Contact information
Practice address
304 E OGDEN AVE, NAPERVILLE, IL 60563-3159
(630) 717-8575
(630) 717-8573
Mailing address
304 E OGDEN AVE, NAPERVILLE, IL 60563-3159
(630) 717-8575
(630) 717-8573
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02232434
BCBS
IL
01
—
7268512
MEDICARE MANAGE CARE #
IL
01
—
DB0886
RAILROAD #
IL
01
—
P00086076
UPIN RAILROAD MEDICARE
IL
Enumeration date
02/21/2007
Last updated
08/22/2020
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