NPIMap

Organization Active NPI

Active Family Chiropractic, LLC

Doing business as Active Family Chiropractic

  • Sports Physician Chiropractor
  • Gresham, OR
National Provider Identifier
1104221530
Registry record updated Oct 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
3666 Issued in OR
Legal business name
ACTIVE FAMILY CHIROPRACTIC, LLC
Doing business as
Active Family Chiropractic
Practice address
501 NE Hood Ave
Suite 205
Gresham, OR 97030-7303
Phone
(503) 674-7894
Fax
(503) 674-7899
NPI assigned
Oct 28, 2014
Last updated
Oct 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michelle K Waggoner, DCNPI 1316091275
Title
President
Phone
(503) 674-7894

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 3666 OR Primary
Pediatric Chiropractor 111NP0017X 3725 OR

Addresses

Primary practice location

501 NE Hood Ave
Suite 205
Gresham, OR 97030-7303

Mailing address

501 NE Hood Ave
Suite 205
Gresham, OR 97030-7303
Phone (503) 674-7894

Other names 1

  • Active Family Chiropractic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414454400000",
    "number": "1104221530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 NE HOOD AVE",
            "address_2": "SUITE 205",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307303",
            "telephone_number": "503-674-7894",
            "fax_number": "503-674-7899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 NE HOOD AVE",
            "address_2": "SUITE 205",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307303",
            "telephone_number": "503-674-7894",
            "fax_number": "503-674-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE FAMILY CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2014-10-28",
        "status": "A",
        "authorized_official_last_name": "WAGGONER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-674-7894",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "OR",
            "license": "3666",
            "primary": true
        },
        {
            "code": "111NP0017X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": "OR",
            "license": "3725",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Family Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.