Provider Demographics
NPI:1336520964
Name:ACTIVE FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:ACTIVE FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARLSON BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-712-9444
Mailing Address - Street 1:2121 S MILL AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2138
Mailing Address - Country:US
Mailing Address - Phone:602-712-9444
Mailing Address - Fax:602-258-7844
Practice Address - Street 1:2121 S MILL AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2138
Practice Address - Country:US
Practice Address - Phone:602-712-9444
Practice Address - Fax:602-258-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty