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General NPI Number Information
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NPI Number | 1861573974
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Entity Type | Organization
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Legal Business Name | ACTIVECARE CHIROPRACTIC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1804 BROADWAY ST STE 125
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2686
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Country | US
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Telephone | 320-763-0313
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Fax | 320-763-6534
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Provider Business Mailing Address
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Address Line | 1804 BROADWAY ST STE 125
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2686
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Country | US
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Telephone | 320-763-0313
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Fax | 320-763-4635
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAIJA MICHON JOHNSON
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Credential | DC
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Telephone | 320-763-0313
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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 | MN4390
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License Number State | MN
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