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General NPI Number Information
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NPI Number | 1437462124
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Entity Type | Organization
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Legal Business Name | ACTIVE CHIROPRACTIC AND WELLNESS
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 2200 COLONIAL AVE SUITE 2
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City | NORFOLK
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State | VA
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Zip | 23517-1915
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Country | US
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Telephone | 757-622-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 COLONIAL AVE SUITE 2
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City | NORFOLK
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State | VA
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Zip | 23517-1915
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Country | US
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Telephone | 757-622-8777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON MATTHEW KING
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Credential | D.C.
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Telephone | 703-371-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0104556532
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License Number State | VA
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