Provider Demographics
NPI:1437394582
Name:ACTIVE BODY CHIROPRACTIC
Entity type:Organization
Organization Name:ACTIVE BODY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HOMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-254-1222
Mailing Address - Street 1:5455 S. FORTE APACHE RD
Mailing Address - Street 2:#108-21
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-254-1222
Mailing Address - Fax:702-254-1218
Practice Address - Street 1:8945 W. POST RD.
Practice Address - Street 2:STE #105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-254-1222
Practice Address - Fax:702-254-1218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE BODY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty