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General NPI Number Information
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NPI Number | 1073066353
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Entity Type | Organization
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Legal Business Name | ACTIVE WELLNESS CHIROPRACTIC
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 1920 N SCOTTSDALE RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-2119
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Country | US
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Telephone | 480-994-0072
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 N SCOTTSDALE RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-2119
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Country | US
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Telephone | 480-994-0072
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN LUEDKE
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Credential | DC
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Telephone | 319-427-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 8565
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License Number State | AZ
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