NPIMap

Organization Active NPI

Active Life & Sports Chiropractic LLC

  • Chiropractor
  • Lombard, IL
National Provider Identifier
1154780617
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038011082 Issued in IL
Legal business name
ACTIVE LIFE & SPORTS CHIROPRACTIC LLC
Practice address
929 S Main St
Unit 107a
Lombard, IL 60148-3325
Phone
(630) 519-6284
Fax
(866) 443-0749
NPI assigned
Feb 12, 2016
Last updated
Feb 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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

Authorized official

Name
Dr. Frank W Frydrych Jr., D.C.NPI 1780869339
Title
Owner
Phone
(630) 519-6284

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038011082 IL Primary

Addresses

Primary practice location

929 S Main St
Unit 107a
Lombard, IL 60148-3325

Mailing address

929 S Main St
Unit 107a
Lombard, IL 60148
Phone (630) 519-6284

Other identifiers 1

IdentifierTypeStateIssuer
R00055OtherILMEDICARE PTAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1455235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455235200000",
    "number": "1154780617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 S MAIN ST",
            "address_2": "UNIT 107A",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "60148",
            "telephone_number": "630-519-6284",
            "fax_number": "866-443-0749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 S MAIN ST",
            "address_2": "UNIT 107A",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601483325",
            "telephone_number": "630-519-6284",
            "fax_number": "866-443-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE & SPORTS CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-12",
        "last_updated": "2016-02-12",
        "status": "A",
        "authorized_official_last_name": "FRYDRYCH",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-519-6284",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "R00055",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lombard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.