Healthcare Provider Details

I. General information

NPI: 1336328616
Provider Name (Legal Business Name): ACTIVE CARE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAIN ST
STEVENSVILLE MT
59870-2111
US

IV. Provider business mailing address

212 MAIN ST
STEVENSVILLE MT
59870-2111
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-1048
  • Fax:
Mailing address:
  • Phone: 406-777-1048
  • Fax: 406-777-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1154
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: RENEE CHRISTENSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 406-777-1048