Provider Demographics
NPI:1215167481
Name:ACTIVE CHOICES CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:ACTIVE CHOICES CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-570-5675
Mailing Address - Street 1:PO BOX 6262
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-6262
Mailing Address - Country:US
Mailing Address - Phone:732-570-5675
Mailing Address - Fax:
Practice Address - Street 1:18 TUTOR PL
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3658
Practice Address - Country:US
Practice Address - Phone:732-570-5675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty