Provider Demographics
NPI:1861218844
Name:ACTIVE LIFE CHIROPRACTIC
Entity type:Organization
Organization Name:ACTIVE LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HUBERT
Authorized Official - Last Name:STEPP
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:605-877-5748
Mailing Address - Street 1:2106 SUNTORY AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-3340
Mailing Address - Country:US
Mailing Address - Phone:605-877-5748
Mailing Address - Fax:
Practice Address - Street 1:1201 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3660
Practice Address - Country:US
Practice Address - Phone:605-877-5748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty