MEDICARE: ACTIVE CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00003086	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0157580	OTHER	WA	DEPT. OF LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1780668228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	3507 NE SUNSET BLVD
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-3330
Country	:	US
Telephone Number	:	425-277-0222
Fax Number	:	425-277-0246

Provider Business Practice Location Address
First Line	:	3507 NE SUNSET BLVD
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-3330
Country	:	US
Telephone Number	:	425-277-0222
Fax Number	:	425-277-0246

Authorized Official
Title or Position	:	PRESIDENT OWNER PROVIDER
Name	:	DR. JOSEPH TAYLOR AARON
Credential	:	DC
Telephone Number	:	425-277-0222

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	09/15/2010

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Directions to “ACTIVE CHIROPRACTIC INC ” Practice Location

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