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General NPI Number Information
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NPI Number | 1851649347
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Entity Type | Organization
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Legal Business Name | ACTIVE RECOVERY CENTERS
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 721 COLORADO AVE
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City | STUART
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State | FL
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Zip | 34994-3017
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Country | US
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Telephone | 772-283-3456
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Fax | 772-283-6789
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Provider Business Mailing Address
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Address Line | 721 COLORADO AVE
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City | STUART
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State | FL
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Zip | 34994-3017
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Country | US
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Telephone | 772-283-3456
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Fax | 772-283-6789
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Authorized Official
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Title or Position | PRESEDENT
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Name | DR. RYAN A GRAND
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Credential | D.C.
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Telephone | 772-283-3456
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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 | 8588
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License Number State | FL
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