Provider Demographics
NPI:1124195805
Name:ACTIVE CHIROPRACTIC HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:ACTIVE CHIROPRACTIC HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINSON
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-885-7555
Mailing Address - Street 1:120 E JOHN ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-3036
Mailing Address - Country:US
Mailing Address - Phone:775-885-7555
Mailing Address - Fax:775-882-6666
Practice Address - Street 1:120 E JOHN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-3036
Practice Address - Country:US
Practice Address - Phone:775-885-7555
Practice Address - Fax:775-882-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV34958Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER