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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

NPI Number 1063832798
LBN Legal business name ACTIVE HEALTH EAU CLAIRE
Authorized official JUDY SOBOROWICZ - (MEMBER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/21/2014
Last updated 04/21/2014 - About 12 years ago
Identifiers
WI License # 3103
WI License # 3207
WI Medicaid 1104883404
WI Medicaid 1255442729
WI Other 000070863 PTAN
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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