Provider Demographics
NPI:1366537359
Name:ACTIVE SPINE & REHAB CENTER, PLLC
Entity type:Organization
Organization Name:ACTIVE SPINE & REHAB CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CHARLET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-302-1497
Mailing Address - Street 1:8224 COTTSBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078
Mailing Address - Country:US
Mailing Address - Phone:704-302-1497
Mailing Address - Fax:
Practice Address - Street 1:8224 COTTSBROOKE DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-302-1497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty