ACTIVE FAMILY CHIROPRACTIC, LLC (NPI# 1417311531) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417311531 |
| Entity Type | Organization |
| Organization Name | ACTIVE FAMILY CHIROPRACTIC, LLC |
| Practice Address |
4 Mylin Ave Willow Street PA 17584-9305 |
| Practice Telephone | 7179477283 |
| Practice Fax Number | 7179477284 |
| Mailing Telephone | 7179477283 |
| Mailing Fax Number | 7179477284 |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2016-04-06 |
| Authorized Official Name | DR. BARRY DANIEL HAZEN (SOLE MEMBER/OWNER) |
| Authorized Official Telephone | 7179477283 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
DC010513 | PA | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104221530 | Active Family Chiropractic, LLC | Chiropractor | 501 Ne Hood Ave, Suite 205, Gresham, OR 97030-7303 | 2014-10-28 |
| 1487086591 | Active Family Chiropractic, LLC | Chiropractor | 117 S Sunset St, Ste H, Longmont, CO 80501-6180 | 2013-07-31 |
| 1891090395 | Active Family Chiropractic, LLC | Clinic/Center | 1404 Triad Center Dr, Saint Peters, MO 63376-7351 | 2011-01-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | ACTIVE FAMILY CHIROPRACTIC, LLC | 122 N Federal Ave, Mason City, IA 50401 |
| Street Address |
4 MYLIN AVE |
| City | WILLOW STREET |
| State | PA |
| Zip Code | 17584-9305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225335755 | Barry D Hazen | Chiropractor | 4 Mylin Ave, Willow Street, PA 17584-9305 | 2011-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396397873 | Bethany M Noll | Audiologist-Hearing Aid Fitter | 226 Willow Valley Lakes Drive, Suite D, Willow Street, PA 17584 | 2019-07-15 |
| 1720546070 | Michelle Beachy | Licensed Practical Nurse | 212 Willow Lakes Drive, Suite 208, Willow Street, PA 17584 | 2019-03-06 |
| 1295293603 | Mary Florida | Registered Nurse | Department of Veteran Affiars, 212 Willow Valley Lakes Drive, Willow Street, PA 17584 | 2019-03-05 |
| 1275069494 | Victoria Vanburen | Counselor | 2819 Willow Street Pike, Willow Street, PA 17584 | 2017-05-08 |
| 1528505245 | Beverly Gooden | Pharmacist | 2600 Willow St. Pike, Willow St., PA 17584 | 2017-01-20 |
| 1902357544 | White Family Dental - Willow Street | Dentist | 212 Willow Valley Drive, Suite 209, Willow Street, PA 17584 | 2016-10-19 |
| 1134482144 | Alexis H Le | Pharmacist | 2600 N Willow Street Pike, Kmart Pharmacy #3810, Willow Street, PA 17584 | 2012-06-25 |
| 1992020309 | Elizabeth A Trozzo | Pharmacist | 2600 Willow Street Pike, Willow Street, PA 17584 | 2010-03-30 |
| 1295987642 | Nu Smile Family Dentistry | Dentist | 2600 Willowstreet Pike, Ste# 310, Willo W Street, PA 17584 | 2008-10-16 |
| 1629255948 | T W Ponessa and Associates Counseling Services Inc | Community/Behavioral Health | 730 Hans Herr Drive, Willow Street, PA 17584 | 2008-01-29 |
| Find all providers in zip 17584 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| Find all providers with the same taxonomy | ||||
| City | WILLOW STREET |
| Zip Code | 17584 |
Please comment or provide details below to improve the information on ACTIVE FAMILY CHIROPRACTIC, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.