Healthcare Provider Details

I. General information

NPI: 1598951329
Provider Name (Legal Business Name): ACTIVE LIFE HEALTH CENTER L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 HAMMOND DR NE SUITE D 4285
ATLANTA GA
30328-5320
US

IV. Provider business mailing address

1155 HAMMOND DR NE SUITE D 4285
ATLANTA GA
30328-5320
US

V. Phone/Fax

Practice location:
  • Phone: 770-522-9800
  • Fax: 770-522-9878
Mailing address:
  • Phone: 770-522-9800
  • Fax: 770-522-9878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCHIROO7525
License Number StateGA

VIII. Authorized Official

Name: DR. JUDD WEINBERG
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 770-522-9800