Provider Demographics
NPI:1780668228
Name:ACTIVE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ACTIVE CHIROPRACTIC INC
Other - Org Name:ACTIVE CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-277-0222
Mailing Address - Street 1:3507 NE SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3330
Mailing Address - Country:US
Mailing Address - Phone:425-277-0222
Mailing Address - Fax:425-277-0246
Practice Address - Street 1:3507 NE SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3330
Practice Address - Country:US
Practice Address - Phone:425-277-0222
Practice Address - Fax:425-277-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0157580OtherDEPT. OF LABOR & INDUSTRIES
AB28217Medicare ID - Type Unspecified
U55476Medicare UPIN