Healthcare Provider Details

I. General information

NPI: 1023670056
Provider Name (Legal Business Name): ACTIVE MEDICAL NAPERVILLE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2019
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 FREEDOM DR STE 117
NAPERVILLE IL
60563-5703
US

IV. Provider business mailing address

1811 FREEDOM DR STE 117
NAPERVILLE IL
60563-5703
US

V. Phone/Fax

Practice location:
  • Phone: 630-225-8750
  • Fax:
Mailing address:
  • Phone: 630-225-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY JOSEPH DARNELL
Title or Position: OWNER
Credential: DC
Phone: 847-836-5202