Active Living Chiropractic, LLC
Organization Active NPI Chiropractor · Mount Orab, OH
NPI 1780920975 · NPPES record last updated Jan 31, 2013
Key facts
- NPI
- 1780920975
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4218 (OH)
- Legal business name
- ACTIVE LIVING CHIROPRACTIC, LLC
- Practice address
- 453 W Main St
Mount Orab, OH 45154-8600 - Phone
- (937) 444-6000
- NPI assigned
- Dec 17, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Lydia D Ogden, D.C.
- Title
- Owner/Chiropractor
- Phone
- (937) 444-6000
Practitioners 1
-
Lydia Ogden, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130215000481 | OH | Part B Supplier - Clinic/Group Practice | 1759535990 |
Receives reassigned benefits from 1 practitioner Practice locations: Mount Orab, OH |
National Provider Directory
Locations
453 W Main St
Mount Orab, OH 45154
Phone (937) 444-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4218 | OH | Yes |
Addresses
Primary practice location
453 W Main St
Mount Orab, OH 45154-8600
Mailing address
453 W Main St
Mount Orab, OH 45154-8600
Other providers in Mount Orab, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.