NPIMap

Organization Active NPI

Active Life Chiropractic and Rehab, LLC

  • Chiropractor
  • Tualatin, OR
National Provider Identifier
1891196739
Registry record updated May 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5551 Issued in OR
Legal business name
ACTIVE LIFE CHIROPRACTIC AND REHAB, LLC
Practice address
8365 SW Warm Springs St
Tualatin, OR 97062-9003
Phone
(503) 855-3375
Fax
(503) 855-3043
NPI assigned
Sep 10, 2014
Last updated
May 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2015

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

Authorized official

Name
Rachel Kohn, D.C.NPI 1619396256
Title
Doctor/Owner
Phone
(503) 855-3375

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5551 OR Primary

Addresses

Primary practice location

8365 SW Warm Springs St
Tualatin, OR 97062-9003

Mailing address

8365 SW Warm Springs St
Tualatin, OR 97062-9003
Phone (503) 855-3375

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150407000533 OR Part B Supplier - Clinic/Group Practice 7012235898 Receives reassigned benefits from 2 practitioners
Practice locations: Tualatin, OR

National Provider Directory

National Provider Directory

Locations

8365 SW Warm Springs St
Tualatin, OR 97062
Phone (503) 855-3375

8373 SW Warm Springs St
Tualatin, OR 97062
Phone (503) 855-3375

Practitioners & affiliated clinicians

Practitioners 5

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": "1410307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431993600000",
    "number": "1891196739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8365 SW WARM SPRINGS ST",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970629003",
            "telephone_number": "503-855-3375",
            "fax_number": "503-855-3043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8365 SW WARM SPRINGS ST",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970629003",
            "telephone_number": "503-855-3375",
            "fax_number": "503-855-3043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE CHIROPRACTIC AND REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-10",
        "last_updated": "2015-05-19",
        "status": "A",
        "authorized_official_last_name": "KOHN",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "503-855-3375",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.