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General NPI Number Information
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NPI Number | 1356707772
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Entity Type | Organization
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Legal Business Name | ACTIVE CARE CHIROPRACTIC, FOGG PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1775 HARRISON AVE
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City | EUREKA
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State | CA
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Zip | 95501-1338
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Country | US
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Telephone | 707-445-8080
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Fax | 707-445-8088
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Provider Business Mailing Address
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Address Line | 1775 HARRISON AVE
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City | EUREKA
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State | CA
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Zip | 95501-1338
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Country | US
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Telephone | 707-445-8080
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Fax | 707-445-8088
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | KATHERINE GOETZ
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Credential |
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Telephone | 606-207-4630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC0267190
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License Number State | CA
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