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General NPI Number Information
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NPI Number | 1720101298
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE CENTER, PLC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18777 N 32ND ST SUITE 80
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City | PHOENIX
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State | AZ
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Zip | 85050-3201
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Country | US
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Telephone | 602-923-3563
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Fax | 602-923-3624
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Provider Business Mailing Address
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Address Line | 18777 N 32ND ST SUITE 80
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City | PHOENIX
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State | AZ
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Zip | 85050-3201
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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 | OFFICE MANAGER
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Name | MS. SHERI WARREN
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Credential |
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Telephone | 602-923-3563
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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 | 5929
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License Number State | AZ
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