Healthcare Provider Details

I. General information

NPI: 1356707772
Provider Name (Legal Business Name): ACTIVE CARE CHIROPRACTIC, FOGG PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 HARRISON AVE
EUREKA CA
95501-1338
US

IV. Provider business mailing address

1775 HARRISON AVE
EUREKA CA
95501-1338
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8080
  • Fax: 707-445-8088
Mailing address:
  • Phone: 707-445-8080
  • Fax: 707-445-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC0267190
License Number StateCA

VIII. Authorized Official

Name: KATHERINE GOETZ
Title or Position: BILLING MANAGER
Credential:
Phone: 606-207-4630