Healthcare Provider Details

I. General information

NPI: 1376278846
Provider Name (Legal Business Name): PRO ACTIVE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 SW ELLIPSE WAY UNIT C16
STUART FL
34997-7275
US

IV. Provider business mailing address

7811 SW ELLIPSE WAY UNIT C16
STUART FL
34997-7275
US

V. Phone/Fax

Practice location:
  • Phone: 772-210-4533
  • Fax:
Mailing address:
  • Phone: 772-210-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BRANDON RHODES
Title or Position: OWNER
Credential: DC
Phone: 561-676-6256