Provider Demographics
NPI:1790825370
Name:ACTIVE LIVING CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ACTIVE LIVING CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-644-2225
Mailing Address - Street 1:4900 SW GRIFFITH DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4649
Mailing Address - Country:US
Mailing Address - Phone:503-644-2225
Mailing Address - Fax:503-644-2226
Practice Address - Street 1:4900 SW GRIFFITH DR STE 110
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4649
Practice Address - Country:US
Practice Address - Phone:503-644-2225
Practice Address - Fax:503-644-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3598111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty