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NPI 1104221530

OrganizationActive

Active Family Chiropractic, LLC

NPI 1104221530 · Sports Physician Chiropractor · Gresham, OR

Provider details

NPI number: 1104221530
Entity type: Organization
Primary specialty: Sports Physician ChiropractorChiropractic Providers
Authorized official: Michelle Waggoner, President
License: 3725 (OR)

Practice location

501 Ne Hood Ave

Suite 205

Gresham, OR 97030-7303

Phone: (503) 674-7894

Fax: (503) 674-7899

More OR providers

Mailing address

501 Ne Hood Ave

Gresham, OR 97030-7303

Registry dates

Enumerated: 2014-10-28
Last updated: 2014-10-28

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Active Family Chiropractic, LLC — NPI 1104221530, Gresham, OR | NPI Central