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General NPI Number Information
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NPI Number | 1730716408
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Entity Type | Organization
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Legal Business Name | ATTIVO WELLNESS LLC
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 1550 W HORIZON RIDGE PKWY # R612
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City | HENDERSON
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State | NV
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Zip | 89012-3600
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Country | US
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Telephone | 310-212-7006
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Fax | 310-212-7006
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Provider Business Mailing Address
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Address Line | 1550 W HORIZON RIDGE PKWY # R612
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City | HENDERSON
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State | NV
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Zip | 89012-3600
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Country | US
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Telephone | 310-212-7006
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Fax | 310-212-7006
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. EDWARD CUNNINGHAM
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Credential | DC
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Telephone | 310-212-7006
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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 |
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License Number State |
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