Provider Demographics
NPI:1013583731
Name:COLLARD CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COLLARD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-569-1141
Mailing Address - Street 1:9071 S 1300 W STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6694
Mailing Address - Country:US
Mailing Address - Phone:801-569-1141
Mailing Address - Fax:801-569-1171
Practice Address - Street 1:9071 S 1300 W STE 105
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6694
Practice Address - Country:US
Practice Address - Phone:801-569-1141
Practice Address - Fax:801-569-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty