Healthcare Provider Details

I. General information

NPI: 1962586818
Provider Name (Legal Business Name): ACTIVE HEALTH CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13712 NE 20TH AVE SUITE A
VANCOUVER WA
98686-2702
US

IV. Provider business mailing address

13712 NE 20TH AVE SUITE A
VANCOUVER WA
98686-2702
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-5944
  • Fax: 360-574-6430
Mailing address:
  • Phone: 360-574-5944
  • Fax: 360-574-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003537
License Number StateWA

VIII. Authorized Official

Name: DR. PAUL A REED
Title or Position: OWNER
Credential: DC
Phone: 360-574-5944