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General NPI Number Information
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NPI Number | 1932571817
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Entity Type | Organization
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Legal Business Name | NEUROACTIVE HEALTH, LLC
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 2258 W GRAND AVE
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City | CHICAGO
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State | IL
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Zip | 60612-1512
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Country | US
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Telephone | 773-661-2070
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Fax | 773-697-8795
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Provider Business Mailing Address
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Address Line | 2258 W GRAND AVE
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City | CHICAGO
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State | IL
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Zip | 60612-1512
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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 | OWNER
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Name | DR. ADAM MICHAEL BRUENE
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Credential | D.C.
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Telephone | 708-370-6858
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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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