Provider Demographics
NPI:1073892659
Name:SPANISH FORK FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:SPANISH FORK FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CADE
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-804-5342
Mailing Address - Street 1:729 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1146
Mailing Address - Country:US
Mailing Address - Phone:801-804-5342
Mailing Address - Fax:877-825-7020
Practice Address - Street 1:729 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1146
Practice Address - Country:US
Practice Address - Phone:801-804-5342
Practice Address - Fax:877-825-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7952725-1202261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care