Provider Demographics
NPI:1154792802
Name:ACTIVE HEALTH & RESTORATION, LLC
Entity type:Organization
Organization Name:ACTIVE HEALTH & RESTORATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:EARL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-923-5049
Mailing Address - Street 1:640 E SAINT CHARLES RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-3083
Mailing Address - Country:US
Mailing Address - Phone:630-923-5049
Mailing Address - Fax:630-344-0963
Practice Address - Street 1:640 E SAINT CHARLES RD
Practice Address - Street 2:SUITE 107
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-3083
Practice Address - Country:US
Practice Address - Phone:630-923-5049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012819111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty