Provider First Line Business Practice Location Address: 
2790 N. ACADEMY BLVD.
    Provider Second Line Business Practice Location Address: 
ACTIVE CHIROPRACTICE WELLNESS CENTER UNIT 110
    Provider Business Practice Location Address City Name: 
COLORADO SPRINGS
    Provider Business Practice Location Address State Name: 
CO
    Provider Business Practice Location Address Postal Code: 
80917
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
719-636-3080
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/07/2014