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Contact Information

ACTIVE HEALTH EAU CLAIRE
3521 LONDON RD
EAU CLAIRE, WI54701-7861
 Phone: 715-834-6333
 Fax: 715-831-6374
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Chiropractor

111N00000X 35 Chiropractic
Indicates primary specialty

NPI Profile & details for ACTIVE HEALTH EAU CLAIRE · (Female)

NPI # 1063832798
Status Active
Credentials
Entity Individual
Enumeration date 04/21/2014
Last updated 04/21/2014 - About 12 years ago
Sole proprietor 1 Not specified
Identifiers
  • WI License # 3103
  • WI License # 3207
  • WI Medicaid 1104883404
  • WI Medicaid 1255442729
  • WI Other 000070863 PTAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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