NPI 1104221530 · live from the CMS NPI Registry
Active Family Chiropractic, LLC
Chiropractor, Sports Physician in Gresham, OR. National Provider Identifier 1104221530, active.
NPI record
| NPI | 1104221530 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Chiropractor, Sports Physician 111NS0005X |
| Practice location | 501 Ne Hood Ave, Suite 205, Gresham, OR 97030 |
| Practice phone | 503-674-7894 |
| Enumerated | October 28, 2014 |
| Last updated | October 28, 2014 |
| Authorized official | Michelle Waggoner, President |
| Other names | Active Family Chiropractic |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Chiropractor, Pediatric Chiropractor | 111NP0017X | 3725 (OR) |
| Chiropractor, Sports Physician primary | 111NS0005X | 3666 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.