Provider Demographics
NPI:1326456096
Name:ACTIVE CHIROPRACTIC
Entity Type:Organization
Organization Name:ACTIVE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-543-5032
Mailing Address - Street 1:2401 RIVER RD
Mailing Address - Street 2:SUITE
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-5414
Mailing Address - Country:US
Mailing Address - Phone:541-543-5032
Mailing Address - Fax:480-505-1143
Practice Address - Street 1:2401 RIVER RD
Practice Address - Street 2:SUITE
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5414
Practice Address - Country:US
Practice Address - Phone:541-543-5032
Practice Address - Fax:480-505-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5077261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service