Provider Demographics
NPI:1073617098
Name:ACTIVE CARE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:ACTIVE CARE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-478-1507
Mailing Address - Street 1:3201 E MEMORIAL RD STE B
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7093
Mailing Address - Country:US
Mailing Address - Phone:405-478-1507
Mailing Address - Fax:405-478-1592
Practice Address - Street 1:3201 E MEMORIAL RD STE B
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7093
Practice Address - Country:US
Practice Address - Phone:405-478-1507
Practice Address - Fax:405-478-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty