Provider Demographics
NPI:1215187737
Name:PROACTIVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PROACTIVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC / MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIF
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-570-5461
Mailing Address - Street 1:329 E PLATTE AVE
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:970-458-5216
Mailing Address - Fax:720-247-9072
Practice Address - Street 1:329 E PLATTE AVE
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:970-458-5216
Practice Address - Fax:720-247-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-20
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCR-6282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty