Organization · NPI-2

Active Family Chiropractic, LLC

Chiropractor, Sports Physician · Gresham, OR

NPI number1104221530
StatusActive
Last updated in NPPESOct 28, 2014

Details

NPI
1104221530
Entity type
Organization (NPI-2)
Legal business name
Active Family Chiropractic, LLC
Organization subpart
No
Enumeration date
Oct 28, 2014
Last updated
Oct 28, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
111NS0005X Chiropractor, Sports Physician3666ORYes
111NP0017X Chiropractor, Pediatric Chiropractor3725OR

Other names

  • Active Family Chiropractic (Doing Business As)

Practice location

501 Ne Hood Ave
Suite 205
Gresham, OR 97030-7303

Phone 503-674-7894 · Fax 503-674-7899

Mailing address

501 Ne Hood Ave
Suite 205
Gresham, OR 97030-7303

Phone 503-674-7894 · Fax 503-674-7899

Authorized official

Michelle K Waggoner
President
5036747894

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Chiropractor, Sports Physician providers in Gresham, OR