Provider Demographics
NPI:1083818264
Name:PROCTOR, BRETT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:PROCTOR
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 1:3123 W 5400 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-2271
Mailing Address - Country:US
Mailing Address - Phone:801-967-0825
Mailing Address - Fax:
Practice Address - Street 1:3123 W 5400 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-2271
Practice Address - Country:US
Practice Address - Phone:801-967-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6562898-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor