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General NPI Number Information
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NPI Number | 1891921664
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE CHIROPRACTIC AND WELLNESS CENTER, S.C.
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Dates
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Enumeration Date | 06/06/2009
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Last Update Date | 06/06/2009
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Provider Practice Location Address
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Address Line | 1630 W COLONIAL PKWY
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City | INVERNESS
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State | IL
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Zip | 60067-1209
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Country | US
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Telephone | 847-202-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 W COLONIAL PKWY
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City | INVERNESS
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State | IL
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Zip | 60067-1209
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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 | PRESIDENT
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Name | DR. ELIZABETH ENGEL
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Credential | D.C.
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Telephone | 847-202-8400
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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 | 038010313
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License Number State | IL
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