Provider Demographics
NPI:1376810176
Name:ACTIJOINT, LLC
Entity Type:Organization
Organization Name:ACTIJOINT, LLC
Other - Org Name:THE ACTIVE JOINT INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-651-4876
Mailing Address - Street 1:11762 S STATE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7155
Mailing Address - Country:US
Mailing Address - Phone:801-390-0188
Mailing Address - Fax:801-996-8785
Practice Address - Street 1:11762 S STATE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7155
Practice Address - Country:US
Practice Address - Phone:801-495-3539
Practice Address - Fax:801-996-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6453925-1205208D00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty