Healthcare Provider Details

I. General information

NPI: 1467383646
Provider Name (Legal Business Name): ACTIVE LIFE CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1659 JEFFERSON ST SE STE 2
ATHENS AL
35611-4548
US

IV. Provider business mailing address

1659 JEFFERSON ST SE STE 2
ATHENS AL
35611-4548
US

V. Phone/Fax

Practice location:
  • Phone: 256-443-7572
  • Fax: 256-443-7572
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BRYANNA HARDIN
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 256-443-7572