Provider Demographics
NPI:1962902395
Name:ACTIVE RESTORATIVE THERAPEUTICS LLC
Entity type:Organization
Organization Name:ACTIVE RESTORATIVE THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-428-7539
Mailing Address - Street 1:777 COMMERCIAL ST SE UNIT 213
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0060
Mailing Address - Country:US
Mailing Address - Phone:941-538-8243
Mailing Address - Fax:
Practice Address - Street 1:1880 LANCASTER DR NE STE 127
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1069
Practice Address - Country:US
Practice Address - Phone:503-428-7539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty