Provider Demographics
NPI:1215234042
Name:ACTIVE LIFE CHIROPRACTIC & WELLNESS
Entity type:Organization
Organization Name:ACTIVE LIFE CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-699-0266
Mailing Address - Street 1:921 LONGTOWN RD
Mailing Address - Street 2:STE. F
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9498
Mailing Address - Country:US
Mailing Address - Phone:803-699-0266
Mailing Address - Fax:
Practice Address - Street 1:921 LONGTOWN RD
Practice Address - Street 2:STE. F
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9498
Practice Address - Country:US
Practice Address - Phone:803-699-0266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty