Provider Demographics
NPI:1023388634
Name:PRECISION CHIROPRACTIC & WELLNESS PLLC
Entity Type:Organization
Organization Name:PRECISION CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-737-1033
Mailing Address - Street 1:859 WASHINGTON BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4972
Mailing Address - Country:US
Mailing Address - Phone:801-737-1033
Mailing Address - Fax:
Practice Address - Street 1:859 WASHINGTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-4972
Practice Address - Country:US
Practice Address - Phone:801-737-1033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000072911OtherMEDICARE PTAN