Provider Demographics
NPI:1083059885
Name:MCENTIRE, ERIC (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MCENTIRE
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 1:12272 S 800 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9789
Mailing Address - Country:US
Mailing Address - Phone:801-676-5550
Mailing Address - Fax:
Practice Address - Street 1:12272 S 800 E
Practice Address - Street 2:SUITE C
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9789
Practice Address - Country:US
Practice Address - Phone:801-676-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7222085-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor