Provider Demographics
NPI:1033277025
Name:OWENS, JEFFREY TODD (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:TODD
Last Name:OWENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 MURRAY HOLLADAY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5185
Mailing Address - Country:US
Mailing Address - Phone:801-277-7120
Mailing Address - Fax:801-277-7146
Practice Address - Street 1:2040 MURRAY HOLLADAY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5185
Practice Address - Country:US
Practice Address - Phone:801-277-7120
Practice Address - Fax:801-277-7146
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6088193-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTV08464Medicare UPIN