Provider Demographics
NPI:1003243619
Name:HEBER VALLEY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HEBER VALLEY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD DOCTOR AND PRES OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-657-5999
Mailing Address - Street 1:2 S MAIN ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1852
Mailing Address - Country:US
Mailing Address - Phone:435-567-5999
Mailing Address - Fax:
Practice Address - Street 1:2 S MAIN ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1852
Practice Address - Country:US
Practice Address - Phone:435-567-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8709683-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty