Organization Active NPI

Activespine LLC

  • Chiropractor
  • Sioux Falls, SD
National Provider Identifier
1790256188
Registry record updated Dec 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
ACTIVESPINE LLC
Practice address
6209 S Old Village PL
Sioux Falls, SD 57108-2100
Phone
(605) 271-8277
Fax
(605) 988-8130
NPI assigned
Dec 10, 2018
Last updated
Dec 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2018

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

Authorized official

Name
Wayne R Huber, DC
Title
Owner
Phone
(605) 271-8277

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

6209 S Old Village PL
Sioux Falls, SD 57108-2100

Mailing address

6209 S Old Village PL
Sioux Falls, SD 57108-2100
Phone (605) 271-8277

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181114002447 SD Part B Supplier - Clinic/Group Practice 6103170923 Receives reassigned benefits from 3 practitioners
Practice locations: Sioux Falls, SD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1544400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544400000000",
    "number": "1790256188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6209 S OLD VILLAGE PL",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082100",
            "telephone_number": "605-271-8277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6209 S OLD VILLAGE PL",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082100",
            "telephone_number": "605-271-8277",
            "fax_number": "605-988-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVESPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-10",
        "last_updated": "2018-12-10",
        "status": "A",
        "authorized_official_last_name": "HUBER",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-271-8277",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2018; 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.