Provider Demographics
NPI:1083991384
Name:SALT LAKE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SALT LAKE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-907-1894
Mailing Address - Street 1:1088 S 1100 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1536
Mailing Address - Country:US
Mailing Address - Phone:801-907-1894
Mailing Address - Fax:
Practice Address - Street 1:1088 S 1100 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-1536
Practice Address - Country:US
Practice Address - Phone:801-907-1894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT81141451202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty