Provider Demographics
NPI:1083624811
Name:PINNACLE CHIROPRACTIC AND SPINAL REHABILITATION INC.
Entity Type:Organization
Organization Name:PINNACLE CHIROPRACTIC AND SPINAL REHABILITATION INC.
Other - Org Name:SEQUOIA CHIROPRACTIC SPORTS & DANCE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:SESSIONS
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-766-4741
Mailing Address - Street 1:289 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2239
Mailing Address - Country:US
Mailing Address - Phone:801-766-4741
Mailing Address - Fax:801-766-8582
Practice Address - Street 1:289 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2239
Practice Address - Country:US
Practice Address - Phone:801-766-4741
Practice Address - Fax:801-766-8582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5352987-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU97781Medicare UPIN