Provider Demographics
NPI:1053854596
Name:CARBON CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CARBON CHIROPRACTIC, PLLC
Other - Org Name:CARBON CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:THAYN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BS, MS
Authorized Official - Phone:435-637-0450
Mailing Address - Street 1:39 N 600 E
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2624
Mailing Address - Country:US
Mailing Address - Phone:435-637-0450
Mailing Address - Fax:
Practice Address - Street 1:39 N 600 E
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2624
Practice Address - Country:US
Practice Address - Phone:435-637-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8399884-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty