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General NPI Number Information
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NPI Number | 1699916858
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE CHIROPRACTIC CENTER, LLC
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 385 MIAMISBURG CENTERVILLE RD
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City | DAYTON
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State | OH
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Zip | 45459-4705
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Country | US
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Telephone | 937-424-9281
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Fax |
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Provider Business Mailing Address
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Address Line | 385 MIAMISBURG CENTERVILLE RD
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City | DAYTON
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State | OH
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Zip | 45459-4705
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Country | US
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Telephone | 937-424-9281
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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. JENNIFER M LEWIS
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Credential | D.C.
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Telephone | 937-424-9281
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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 | 3770
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License Number State | OH
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