Provider Demographics
NPI:1073823902
Name:ACTIVE REHAB & ASSOCIATES
Entity Type:Organization
Organization Name:ACTIVE REHAB & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:DOHERTY
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-236-4044
Mailing Address - Street 1:1009 CHEEK SPARGER RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3880
Mailing Address - Country:US
Mailing Address - Phone:806-236-4044
Mailing Address - Fax:
Practice Address - Street 1:1009 CHEEK SPARGER RD
Practice Address - Street 2:SUITE 124
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3880
Practice Address - Country:US
Practice Address - Phone:806-236-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10973111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty