MEDICARE: ACTIVE CHIROPRACTIC, LLC

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	CH10813	FL
2	111N00000X	Chiropractor	CH9770	FL

General Provider Information

NPI Number	:	1558880849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	28051 US HIGHWAY 19 N STE 106
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-2642
Country	:	US
Telephone Number	:	727-400-6000
Fax Number	:	727-999-6001

Provider Business Practice Location Address
First Line	:	28051 US HIGHWAY 19 N STE 106
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-2642
Country	:	US
Telephone Number	:	727-400-6000
Fax Number	:	727-999-6001

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIA A YOUNG
Credential	:	DC
Telephone Number	:	727-400-6000

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	07/08/2024

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Directions to “ACTIVE CHIROPRACTIC, LLC ” Practice Location

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