Organization
ACTIVE FAMILY CHIROPRACTIC, LLC
Active
Other names
Active Family Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE K WAGGONER DC (PRESIDENT)
(503) 674-7894
Entity
Organization
Contact information
Practice address
501 NE HOOD AVE, SUITE 205, GRESHAM, OR 97030-7303
(503) 674-7894
(503) 674-7899
Mailing address
501 NE HOOD AVE, SUITE 205, GRESHAM, OR 97030-7303
(503) 674-7894
(503) 674-7899
Taxonomy
Speciality
Code
Description
License number
State
111NP0017X
Pediatric Chiropractor
3725
OR
111NS0005X
Sports Physician Chiropractor
Primary
3666
OR
Other
Enumeration date
10/28/2014
Last updated
10/28/2014
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