MEDICARE: ACTIVE HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6026	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6026	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1164642765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 1844
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75221-1844
Country	:	US
Telephone Number	:	214-220-9177
Fax Number	:	214-220-0410

Provider Business Practice Location Address
First Line	:	1717 MAIN ST STE 5640
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-7348
Country	:	US
Telephone Number	:	241-220-9117
Fax Number	:	214-220-0410

Authorized Official
Title or Position	:	CHIROPRACTOR OWNER
Name	:	DR. MICHAEL FLEMING WILLIAMS
Credential	:	D C
Telephone Number	:	214-220-3177

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/22/2020

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Directions to “ACTIVE HEALTH SERVICES ” Practice Location

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