Provider Demographics
NPI:1063868776
Name:ACTIVE HEALTH SOLUTIONS PS
Entity type:Organization
Organization Name:ACTIVE HEALTH SOLUTIONS PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-486-1648
Mailing Address - Street 1:101 NICKERSON ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1620
Mailing Address - Country:US
Mailing Address - Phone:206-486-1648
Mailing Address - Fax:206-832-3732
Practice Address - Street 1:101 NICKERSON ST STE 140
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1620
Practice Address - Country:US
Practice Address - Phone:206-486-1648
Practice Address - Fax:206-832-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60636464111N00000X
WACH60636464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty