| Active Life Llc | |
|
2804 Forum Blvd Ste 1a Columbia MO 65203-6322 | |
| (573) 999-7805 | |
| (573) 446-4949 |
| Full Name | Active Life Llc |
|---|---|
| Speciality | General Practice |
| Location | 2804 Forum Blvd Ste 1a, Columbia, Missouri |
| Authorized Official Name and Position | Samuel Henley (DOCTOR) |
| Authorized Official Contact | 5733561876 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Life Llc 2804 Forum Blvd Ste 1a Columbia MO 65203-6322 Ph: (573) 999-7805 | Active Life Llc 2804 Forum Blvd Ste 1a Columbia MO 65203-6322 Ph: (573) 999-7805 |
| NPI Number | 1922577659 |
|---|---|
| Provider Enumeration Date | 11/26/2018 |
| Last Update Date | 06/19/2025 |
| Medicare PECOS PAC ID | 8527307842 |
|---|---|
| Medicare Enrollment ID | O20190305001135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922577659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Samuel T Henley |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1922305267 PECOS PAC ID: 7719163542 Enrollment ID: I20110512000355 |
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