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General NPI Number Information
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NPI Number | 1427179787
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Entity Type | Organization
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Legal Business Name | ACTIVE HEALTH AND WELLNESS CENTER
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 3027 MISHAWAKA AVE
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City | SOUTH BEND
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State | IN
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Zip | 46615-2347
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Country | US
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Telephone | 574-259-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 3027 MISHAWAKA AVE
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City | SOUTH BEND
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State | IN
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Zip | 46615-2347
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | DR. LISA MEYERS
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Credential |
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Telephone | 574-259-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 51000262A
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License Number State | IN
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