Provider Demographics
NPI:1144432279
Name:ACTIVE FAMILY CHIROPRACTIC, PC
Entity type:Organization
Organization Name:ACTIVE FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SALWEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-364-9362
Mailing Address - Street 1:2808 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:701-364-9362
Mailing Address - Fax:701-365-0644
Practice Address - Street 1:2808 N BROADWAY
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:701-364-9362
Practice Address - Fax:701-365-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12210Medicaid
ND12210Medicaid