NPIMap

Organization Active NPI

Active Wellness LLC

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1447685052
Registry record updated Oct 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
ACTIVE WELLNESS LLC
Practice address
338 E Ohio
Chicago, IL 60611
Phone
(773) 328-8153
Fax
(773) 273-6736
NPI assigned
Sep 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2013

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

Authorized official

Name
Andrew Ingley
Title
Manager
Phone
(813) 220-9113

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary
Nutrition ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NN1001X
Pediatric ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NP0017X
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X

Addresses

Primary practice location

338 E Ohio
Chicago, IL 60611

Mailing address

4555 N Lincoln Ave
Chicago, IL 60625-2102
Phone (773) 328-8153

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130627000369 IL Part B Supplier - Clinic/Group Practice 3072752864 Receives reassigned benefits from 59 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Active Wellness LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381190400000",
    "number": "1447685052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4555 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252102",
            "telephone_number": "773-328-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 E OHIO",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60611",
            "telephone_number": "773-328-8153",
            "fax_number": "773-273-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-13",
        "last_updated": "2013-10-08",
        "status": "A",
        "authorized_official_last_name": "INGLEY",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-220-9113"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111NP0017X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2013; 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.