Provider Demographics
NPI:1255844239
Name:ACTIVE FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ACTIVE FAMILY CHIROPRACTIC INC
Other - Org Name:ACTIVE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-232-0732
Mailing Address - Street 1:550 W 465 N UNIT 502
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-8015
Mailing Address - Country:US
Mailing Address - Phone:435-232-0732
Mailing Address - Fax:435-514-1814
Practice Address - Street 1:550 W 465 N UNIT 502
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-8015
Practice Address - Country:US
Practice Address - Phone:435-232-0732
Practice Address - Fax:435-514-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT65098601202111N00000X
111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty