Provider Demographics
NPI:1417180829
Name:ACTIVE WELLNESS CHIROPRACTIC & REHABILITATION, LLC.
Entity type:Organization
Organization Name:ACTIVE WELLNESS CHIROPRACTIC & REHABILITATION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:RECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-729-1266
Mailing Address - Street 1:8711 WINDSOR PKWY STE 7
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2296
Mailing Address - Country:US
Mailing Address - Phone:515-867-2900
Mailing Address - Fax:
Practice Address - Street 1:8711 WINDSOR PKWY STE 7
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2296
Practice Address - Country:US
Practice Address - Phone:515-729-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007232111N00000X
IA007220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty