Provider Demographics
NPI:1003354457
Name:GENERATIONS CHIROPRACTIC
Entity Type:Organization
Organization Name:GENERATIONS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN SLOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-250-7669
Mailing Address - Street 1:3424 S 2300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3022
Mailing Address - Country:US
Mailing Address - Phone:801-486-9201
Mailing Address - Fax:
Practice Address - Street 1:3424 S 2300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-3022
Practice Address - Country:US
Practice Address - Phone:801-486-9201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty