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General NPI Number Information
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NPI Number | 1396540605
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE INTEGRATED HEALTH
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 10/18/2025
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Provider Practice Location Address
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Address Line | 971 W MOANA LN
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City | RENO
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State | NV
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Zip | 89509-4844
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Country | US
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Telephone | 775-870-0914
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Fax | 775-409-3407
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Provider Business Mailing Address
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Address Line | 971 W MOANA LN
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City | RENO
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State | NV
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Zip | 89509-4844
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Country | US
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Telephone | 775-870-0914
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Fax | 775-409-3407
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Authorized Official
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Title or Position | CEO
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Name | MR. VERNON WALDORF
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Credential |
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Telephone | 775-870-0914
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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 |
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License Number State |
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