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ACTIVE HEALTH EAU CLAIRE NPI 1063832798


NPI Information

NPI: 1063832798
Provider Name: ACTIVE HEALTH EAU CLAIRE
Classification: Chiropractor - 111N00000X
Entity Type: Organization
Address:
3521 LONDON RD
EAU CLAIRE, WI
ZIP 54701
Phone: (715) 834-6333
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ACTIVE HEALTH EAU CLAIRE is a chiropractor in Eau Claire, WI. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. ACTIVE HEALTH EAU CLAIRE NPI is 1063832798. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

3521 LONDON RD
EAU CLAIRE, WI
ZIP 54701-861
Phone: (715) 834-6333
Fax: (715) 831-6374

The provider's authorized official is Judy Soborowicz .
The authorized official title is Member and has the following contact phone number (715) 834-6333.

The enumeration date for this NPI number is 4/21/2014 and was last updated on 4/21/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1111N00000XChiropractor3207WISCONSINNo
2111N00000XChiropractor3103WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1U53609MEDICARE UPIN
21255442729MEDICAIDWISCONSIN
3000070876MEDICARE PINWISCONSIN
4000070863OTHERWISCONSINPTAN
5U51112MEDICARE UPINWISCONSIN
61104883404MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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