Healthcare Provider Details

I. General information

NPI: 1598046195
Provider Name (Legal Business Name): ACTIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 S 48TH ST SUITE 108
PHOENIX AZ
85044-1779
US

IV. Provider business mailing address

11011 S 48TH ST SUITE 108
PHOENIX AZ
85044-1779
US

V. Phone/Fax

Practice location:
  • Phone: 480-893-2400
  • Fax: 480-893-2412
Mailing address:
  • Phone: 480-893-2400
  • Fax: 480-893-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7283
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC JAMES NEUFANG
Title or Position: DIRECTOR OF CLINIC
Credential: D.C.
Phone: 480-893-2400