4 Active Health Inc
Organization Active NPI Health Service Clinic/Center · Longmont, CO
NPI 1467909804 · NPPES record last updated Nov 9, 2021
Key facts
- NPI
- 1467909804
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Service Clinic/Center 261QH0100X
- License
- 0004671 (CO)
- Legal business name
- 4 ACTIVE HEALTH INC
- Practice address
- 1225 Ken Pratt Blvd
Suite 222
Longmont, CO 80501-6518 - Phone
- (303) 772-3100
- NPI assigned
- Sep 1, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Jonathan C Shum, DC
- Title
- President
- Phone
- (303) 478-4678
Practitioners 4
-
Jonathan C Shum, DC
-
Andrew Romoda, L.AC
-
Lauren Jordan, L.AC.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220222000922 | CO | Part B Supplier - Clinic/Group Practice | 0547654394 |
Receives reassigned benefits from 1 practitioner Practice locations: Longmont, CO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | |||
| Health Service Clinic/Center | 261QH0100X | 0004671 | CO | Yes |
Addresses
Primary practice location
1225 Ken Pratt Blvd
Suite 222
Longmont, CO 80501-6518
Mailing address
1225 Ken Pratt Blvd
Suite 222
Longmont, CO 80501-6518
Phone (303) 772-3100
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.