Healthcare Provider Details

I. General information

NPI: 1790490035
Provider Name (Legal Business Name): COMPASS PROACTIVE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W BROADWAY STE 100
EUGENE OR
97401-3081
US

IV. Provider business mailing address

3155 PORTLAND ST
EUGENE OR
97405-5140
US

V. Phone/Fax

Practice location:
  • Phone: 541-206-2271
  • Fax: 541-470-8729
Mailing address:
  • Phone: 541-968-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHANE PATRICK TRACEY
Title or Position: MEMBER
Credential:
Phone: 541-206-2271