Provider Demographics
NPI:1356707772
Name:ACTIVE CARE CHIROPRACTIC, BELLINGER/FOGG PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ACTIVE CARE CHIROPRACTIC, BELLINGER/FOGG PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-845-1870
Mailing Address - Street 1:1775 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1338
Mailing Address - Country:US
Mailing Address - Phone:707-445-8080
Mailing Address - Fax:707-445-8088
Practice Address - Street 1:1775 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1338
Practice Address - Country:US
Practice Address - Phone:707-445-8080
Practice Address - Fax:707-445-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0267190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty