Active Care Chatham LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00703800 Issued in NJ

Legal business name

ACTIVE CARE CHATHAM LLC

Practice address

17 Watching Ave
Chatham, NJ 07928-2700

Phone

(973) 635-2605

Fax

(973) 635-2646

NPI assigned

Apr 13, 2015

Organization subpart

No

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

Authorized official

Name

Jennifer Carroll

Title

Office Rep

Phone

(352) 678-3092

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1428883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1164818522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 WATCHING AVE",
            "city": "CHATHAM",
            "state": "NJ",
            "postal_code": "079282700",
            "telephone_number": "973-635-2605",
            "fax_number": "973-635-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WATCHING AVE",
            "city": "CHATHAM",
            "state": "NJ",
            "postal_code": "079282700",
            "telephone_number": "973-635-2605",
            "fax_number": "973-635-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE CARE CHATHAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-13",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE REP",
        "authorized_official_telephone_number": "352-678-3092"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00703800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.