Organization Active NPI

Active Living Chiropractic Inc

  • Chiropractor
  • Greenville, NC
National Provider Identifier
1912220690
Registry record updated Apr 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4057 Issued in NC
Legal business name
ACTIVE LIVING CHIROPRACTIC INC
Practice address
704 E. Arlington Blvd.
Greenville, NC 27858
Phone
(252) 756-6111
Fax
(252) 756-6904
NPI assigned
Mar 9, 2010
Last updated
Apr 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2023

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

Authorized official

Name
Mrs. Tabatha Bullock Wirth
Title
Billing/Wife
Phone
(252) 756-6111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4057 NC Primary

Addresses

Primary practice location

704 E. Arlington Blvd.
Greenville, NC 27858

Mailing address

704 E. Arlington Blvd.
Greenville, NC 27858
Phone (252) 756-6111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100518000645 NC Part B Supplier - Clinic/Group Practice 5698804300 Receives reassigned benefits from 6 practitioners
Practice locations: Greenville, NC

National Provider Directory

National Provider Directory

Locations

704 E Arlington Blvd
Greenville, NC 27858
Phone (252) 756-6111

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": "1268092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1912220690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 E. ARLINGTON BLVD.",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "27858",
            "telephone_number": "252-756-6111",
            "fax_number": "252-756-6904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 E. ARLINGTON BLVD.",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "27858",
            "telephone_number": "252-756-6111",
            "fax_number": "252-756-6904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIVING CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-09",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "WIRTH",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_middle_name": "BULLOCK",
        "authorized_official_title_or_position": "BILLING/WIFE",
        "authorized_official_telephone_number": "252-756-6111",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "4057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; 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.