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General NPI Number Information
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NPI Number | 1487809109
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Entity Type | Organization
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Legal Business Name | ACTIVE HEALTH CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 740 MILFORD WARREN GLEN RD
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City | MILFORD
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State | NJ
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Zip | 08848-1647
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Country | US
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Telephone | 908-995-7200
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Fax | 908-995-0778
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Provider Business Mailing Address
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Address Line | 740 MILFORD WARREN GLEN RD
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City | MILFORD
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State | NJ
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Zip | 08848-1647
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Country | US
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Telephone | 908-995-7200
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Fax | 908-995-0778
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MATHIEU LENTINE
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Credential | D.C.
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Telephone | 908-995-7200
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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 | 38MC00668900
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License Number State | NJ
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