Provider Demographics
NPI:1396540605
Name:ACTIVE LIFE INTEGRATED HEALTH
Entity type:Organization
Organization Name:ACTIVE LIFE INTEGRATED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-870-0914
Mailing Address - Street 1:971 W MOANA LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4844
Mailing Address - Country:US
Mailing Address - Phone:775-870-0914
Mailing Address - Fax:775-409-3407
Practice Address - Street 1:971 W MOANA LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4844
Practice Address - Country:US
Practice Address - Phone:775-870-0914
Practice Address - Fax:775-409-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty