MEDICARE: ACTIVE PLUS REHAB, INC.

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	111NS0005X	Sports Physician Chiropractor	F007684	TX

General Provider Information

NPI Number	:	1417143405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE PLUS REHAB, INC.

Provider Business Mailing Address
First Line	:	8808 CAMP BOWIE W
Second Line	:	SUITE 150
City	:	FORT WORTH
State	:	TX
Zip	:	76116-6028
Country	:	US
Telephone Number	:	817-560-8100
Fax Number	:	817-560-8103

Provider Business Practice Location Address
First Line	:	8808 CAMP BOWIE W
Second Line	:	SUITE 150
City	:	FORT WORTH
State	:	TX
Zip	:	76116-6028
Country	:	US
Telephone Number	:	817-560-8100
Fax Number	:	817-560-8103

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAND H LEWIS
Credential	:	D.C.
Telephone Number	:	817-560-8100

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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