MEDICARE: HEALTHY AND ACTIVE

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	38MC00592500	NJ

General Provider Information

NPI Number	:	1952506206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY AND ACTIVE

Provider Business Mailing Address
First Line	:	29 HIGH ST
Second Line	:
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-1511
Country	:	US
Telephone Number	:	201-444-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 HIGH ST
Second Line	:
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-1511
Country	:	US
Telephone Number	:	201-444-6700
Fax Number	:	201-327-3828

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. RALPH WALTER BYSIEK
Credential	:	D.C.
Telephone Number	:	201-444-6700

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	05/07/2009

Similar Medicare Providers

1538364872 — DR. RALPH WALTER BYSIEK D.C.
Practice Location Address:

29 HIGH ST
ALLENDALE, NJ
07401-1511

Practice Phone: 201-444-6700
Practice Fax: 201-327-3828

1861019382 — MS. CAROL LINDA VIDETTI LCSW
Practice Location Address:

29 HIGH ST
ALLENDALE, NJ
07401-1511

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1427022235 — DR. EDWARD R LEVY OD
Practice Location Address:

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1932176179 — MRS. MARCIA WYRTZEN LCSW
Practice Location Address:

37 E ALLENDALE AVE
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Practice Fax:

1124057237 — COMMUNITY CHIROPRACTIC CENTER, LLC
Practice Location Address:

70 W ALLENDALE AVE , SUITE A
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Practice Phone: 201-818-0900
Practice Fax: 201-818-8809

1881623908 — ALLENDALE NURSING HOME INC
Practice Location Address:

85 HARRETON RD
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Practice Phone: 201-825-0660
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Directions to “HEALTHY AND ACTIVE ” Practice Location

Language	Start Address	Practice Location

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