NPIMap

Organization Active NPI

Active Health Chiropractic Clinic, P.C.

  • Chiropractor
  • West Liberty, IA
National Provider Identifier
1700096989
Registry record updated Mar 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
06934 Issued in IA
Legal business name
ACTIVE HEALTH CHIROPRACTIC CLINIC, P.C.
Practice address
1103 N Elm St
Ste 102
West Liberty, IA 52776-1006
Phone
(319) 627-6461
NPI assigned
May 23, 2007
Last updated
Mar 21, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2013

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

Authorized official

Name
Dr. Dana Lynn Nelson, D.C.NPI 1134191620
Title
President
Phone
(319) 627-6461

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 06934 IA Primary

Addresses

Primary practice location

1103 N Elm St
Ste 102
West Liberty, IA 52776-1006

Mailing address

1103 N Elm St
Ste 102
West Liberty, IA 52776-1006
Phone (319) 627-6461

Other identifiers 1

IdentifierTypeStateIssuer
29848OtherIAWELLMARK BCBS

Other names 1

  • Active Health Chiropractic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070601000120 IA Part B Supplier - Clinic/Group Practice 6406870575 Receives reassigned benefits from 1 practitioner
Practice locations: West Liberty, IA

National Provider Directory

National Provider Directory

Locations

1103 N Elm St
Ste 102
West Liberty, IA 52776
Phone (319) 627-6461

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": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363824000000",
    "number": "1700096989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 N ELM ST",
            "address_2": "STE 102",
            "city": "WEST LIBERTY",
            "state": "IA",
            "postal_code": "527761006",
            "telephone_number": "319-627-6461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 N ELM ST",
            "address_2": "STE 102",
            "city": "WEST LIBERTY",
            "state": "IA",
            "postal_code": "527761006",
            "telephone_number": "319-627-6461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE HEALTH CHIROPRACTIC CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2013-03-21",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "319-627-6461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "06934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "29848",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Health Chiropractic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Liberty, IA

Sources for this page

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