NPIMap

Organization Active NPI

Active Health Eau Claire

  • Chiropractor
  • Eau Claire, WI
National Provider Identifier
1063832798
Registry record updated Apr 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3103 Issued in WI
Legal business name
ACTIVE HEALTH EAU CLAIRE
Practice address
3521 London Rd
Eau Claire, WI 54701-7861
Phone
(715) 834-6333
Fax
(715) 831-6374
NPI assigned
Apr 21, 2014
Last updated
Apr 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judy Soborowicz, DCNPI 1104883404
Title
Member
Phone
(715) 834-6333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 3103 WI Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 3207 WI

Addresses

Primary practice location

3521 London Rd
Eau Claire, WI 54701-7861

Mailing address

3521 London Rd
Eau Claire, WI 54701-7861
Phone (715) 834-6333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140522000773 WI Part B Supplier - Clinic/Group Practice 2264655182 Receives reassigned benefits from 3 practitioners
Practice locations: Eau Claire, WI

National Provider Directory

National Provider Directory

Locations

3521 London Rd
Ste A
Eau Claire, WI 54701
Phone (715) 834-6333

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398038400000",
    "number": "1063832798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3521 LONDON RD",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547017861",
            "telephone_number": "715-834-6333",
            "fax_number": "715-831-6374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3521 LONDON RD",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547017861",
            "telephone_number": "715-834-6333",
            "fax_number": "715-831-6374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE HEALTH EAU CLAIRE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-21",
        "last_updated": "2014-04-21",
        "status": "A",
        "authorized_official_last_name": "SOBOROWICZ",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "715-834-6333",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3103",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3207",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eau Claire, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.