Provider Demographics
NPI:1265877856
Name:ACTIVE OREGON CHIROPRACTIC
Entity type:Organization
Organization Name:ACTIVE OREGON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOLONEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:503-655-2897
Mailing Address - Street 1:130 W CLARENDON ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2335
Mailing Address - Country:US
Mailing Address - Phone:503-655-2897
Mailing Address - Fax:503-655-2854
Practice Address - Street 1:130 W CLARENDON ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2335
Practice Address - Country:US
Practice Address - Phone:503-655-2897
Practice Address - Fax:503-655-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X
OR5140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty