Provider Demographics
NPI:1104397413
Name:PROACTIVE MRI LLC
Entity Type:Organization
Organization Name:PROACTIVE MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIF
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-441-1117
Mailing Address - Street 1:329 E PLATTE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3172
Mailing Address - Country:US
Mailing Address - Phone:970-415-0855
Mailing Address - Fax:720-247-9072
Practice Address - Street 1:329 E PLATTE AVE STE C
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3172
Practice Address - Country:US
Practice Address - Phone:970-415-0855
Practice Address - Fax:720-247-9072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROACTIVE CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-12
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1215187737OtherNPI
1174016331OtherNPI