NPI 1104221530

Active Family Chiropractic, LLC

Organisation Sports Physician Chiropractor Gresham, OR

Practice location

Address: 501 NE Hood Ave Suite 205, Gresham, OR 97030-7303
Phone: (503) 674-7894
Fax: (503) 674-7899

Authorised official

Name: Michelle K Waggoner
Title: President
Phone: (503) 674-7894

Registered specialties (2)

Sports Physician Chiropractor Primary

Chiropractic Providers Taxonomy 111NS0005X Licence 3666 (OR)

Other Chiropractor providers in Oregon →

Pediatric Chiropractor

Chiropractic Providers Taxonomy 111NP0017X Licence 3725 (OR)

Registry record

NPI: 1104221530
Entity type: Organization
NPI issued: 28 Oct 2014
Record last updated: 28 Oct 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.