Pro Active Chiropractic and Sports Medicine PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PRO ACTIVE CHIROPRACTIC AND SPORTS MEDICINE PLLC

Doing business as

Pro Active Chiropractic

Practice address

6638 E Baseline Rd Ste 101
Mesa, AZ 85206-4433

Phone

(480) 534-7330

Fax

(480) 550-7657

NPI assigned

Jan 17, 2024

Last updated

Jan 17, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeff Roderick, DCNPI 1740289248

Title

Owner

Phone

(480) 534-7330

Specialties & licenses 1

Addresses

Other names 1

• Pro Active Chiropractic Doing business as

Practitioners 1

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.

• Jeff R. Roderick, DC

  • Chiropractor
  • Mesa, AZ
  • NPI 1740289248
  NPD Authorized official

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

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1669233763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6638 E BASELINE RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064433",
            "telephone_number": "480-534-7330",
            "fax_number": "480-550-7657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6638 E BASELINE RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064433",
            "telephone_number": "480-534-7330",
            "fax_number": "480-550-7657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO ACTIVE CHIROPRACTIC AND SPORTS MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "RODERICK",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-534-7330",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro Active Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.