Healthcare Provider Details

I. General information

NPI: 1821894510
Provider Name (Legal Business Name): ACTIVE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 WILLAKENZIE RD STE 8
EUGENE OR
97401-4873
US

IV. Provider business mailing address

2677 WILLAKENZIE RD STE 8
EUGENE OR
97401-4873
US

V. Phone/Fax

Practice location:
  • Phone: 541-543-5032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: COLIN OLBERDING
Title or Position: OWNER
Credential: DC
Phone: 858-295-2486