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General NPI Number Information
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NPI Number | 1558880849
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Entity Type | Organization
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Legal Business Name | ACTIVE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 28051 US HIGHWAY 19 N STE 106
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City | CLEARWATER
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State | FL
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Zip | 33761-2642
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Country | US
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Telephone | 727-400-6000
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Fax | 727-999-6001
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Provider Business Mailing Address
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Address Line | 28051 US HIGHWAY 19 N STE 106
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City | CLEARWATER
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State | FL
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Zip | 33761-2642
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Country | US
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Telephone | 727-400-6000
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Fax | 727-999-6001
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA A YOUNG
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Credential | DC
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Telephone | 727-400-6000
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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 | CH10813
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9770
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License Number State | FL
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