Provider Demographics
NPI:1083880025
Name:ASPEN CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:ASPEN CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-234-6325
Mailing Address - Street 1:381 E 800 S
Mailing Address - Street 2:#101
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-6309
Mailing Address - Country:US
Mailing Address - Phone:801-234-6325
Mailing Address - Fax:801-221-1655
Practice Address - Street 1:381 E 800 S
Practice Address - Street 2:#101
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-6309
Practice Address - Country:US
Practice Address - Phone:801-234-6325
Practice Address - Fax:801-221-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT358787-1202111N00000X
IA3948111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty