MEDICARE: ACTIVE LIFE PROJECT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	111NR0400X	Rehabilitation Chiropractor
3	111NS0005X	Sports Physician Chiropractor

General Provider Information

NPI Number	:	1942767975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE LIFE PROJECT

Provider Business Mailing Address
First Line	:	40 MELROSE AVE
Second Line	:
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08108-2314
Country	:	US
Telephone Number	:	856-477-9330
Fax Number	:

Provider Business Practice Location Address
First Line	:	987 HADDON AVE
Second Line	:
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-2048
Country	:	US
Telephone Number	:	856-607-2115
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KELLI M VELEZ
Credential	:	DC
Telephone Number	:	919-225-2065

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	07/26/2019

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Directions to “ACTIVE LIFE PROJECT ” Practice Location

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