Healthcare Provider Details

I. General information

NPI: 1629685763
Provider Name (Legal Business Name): ACTIVEFIT CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10680 JONES RD STE 400
HOUSTON TX
77065-4295
US

IV. Provider business mailing address

10123 HEDGE WAY DR
HOUSTON TX
77065-4165
US

V. Phone/Fax

Practice location:
  • Phone: 832-452-5469
  • Fax:
Mailing address:
  • Phone: 832-452-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. VINH PHU NGUYEN
Title or Position: OWNER/DOCTOR
Credential: D.C.
Phone: 832-452-5469