NPIMap

Organization Active NPI

Active Wellness LLC

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1891120408
Registry record updated Oct 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
ACTIVE WELLNESS LLC
Practice address
560 W Diversey Pkwy
Chicago, IL 60614
Phone
(773) 524-6830
NPI assigned
Sep 13, 2013
Last updated
Oct 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 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
Chiropractor 111N00000X Primary
Nutrition Chiropractor 111NN1001X
Sports Physician Chiropractor 111NS0005X
Acupuncturist 171100000X
Pediatric Chiropractor 111NP0017X

Addresses

Primary practice location

560 W Diversey Pkwy
Chicago, IL 60614

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.

Locations

215 W Superior St
Chicago, IL 60654
Phone (773) 906-5600

2514 N Milwaukee Ave
Chicago, IL 60647
Phone (312) 216-2452

560 W Diversey Pkwy
Chicago, IL 60614
Phone (773) 328-8153

710 Deerfield Rd
Deerfield, IL 60015
Phone (224) 632-1860

134 N York St
Elmhurst, IL 60126
Phone (331) 462-1167

910 Davis St
Evanston, IL 60201
Phone (773) 598-4387

20505 N Rand Rd
Ste 218
Kildeer, IL 60047
Phone (847) 481-8728

1105 N Elmhurst Rd
Mt Prospect, IL 60056
Phone (224) 676-2318

15222 S La Grange Rd
Unit 8
Orland Park, IL 60462
Phone (708) 876-8207

Practitioners & affiliated clinicians

Practitioners 83

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.

View all 83

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": "1380672000000",
    "number": "1891120408",
    "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": "560 W DIVERSEY PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60614",
            "telephone_number": "773-524-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-13",
        "last_updated": "2013-10-02",
        "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": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111NP0017X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "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 2, 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.