Heath Active Spine & Rehab LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC-04383 Issued in OH

Legal business name

HEATH ACTIVE SPINE & REHAB LLC

Practice address

838 S 30TH St
Heath, OH 43056-1254

Phone

(740) 522-6300

Fax

(740) 522-6308

NPI assigned

Jul 13, 2017

Organization subpart

No

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

Authorized official

Name

Michael Gustafson, DC

Title

Member

Phone

(440) 319-5520

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1477075182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "838 S 30TH ST",
            "city": "HEATH",
            "state": "OH",
            "postal_code": "430561254",
            "telephone_number": "740-522-6300",
            "fax_number": "740-522-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "838 S 30TH ST",
            "city": "HEATH",
            "state": "OH",
            "postal_code": "430561254",
            "telephone_number": "740-522-6300",
            "fax_number": "740-522-6308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEATH ACTIVE SPINE & REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "440-319-5520",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "DC-04383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Heath, OH
• Providers in Heath, OH by specialty
• Chiropractor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.