Provider Demographics
NPI:1891986063
Name:ACTIVE FAMILY CHIROPRACTIC AND ACUPUNCTURE PC
Entity Type:Organization
Organization Name:ACTIVE FAMILY CHIROPRACTIC AND ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RIEF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-384-4955
Mailing Address - Street 1:622 N WEBB RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4049
Mailing Address - Country:US
Mailing Address - Phone:308-384-4955
Mailing Address - Fax:
Practice Address - Street 1:622 N WEBB RD
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4049
Practice Address - Country:US
Practice Address - Phone:308-384-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty