Healthcare Provider Details

I. General information

NPI: 1760876338
Provider Name (Legal Business Name): PROACTIVE HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4967 E DUBLIN GRANVILLE RD
WESTERVILLE OH
43081-9703
US

IV. Provider business mailing address

4967 E DUBLIN GRANVILLE RD
WESTERVILLE OH
43081-9703
US

V. Phone/Fax

Practice location:
  • Phone: 614-337-8111
  • Fax:
Mailing address:
  • Phone: 614-337-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3774
License Number StateOH

VIII. Authorized Official

Name: DR. LUCAS PAUL REINHART
Title or Position: OWNER
Credential: D.C.
Phone: 614-337-8111