Provider Demographics
NPI:1093102436
Name:FAVERO CHIROPRACTIC
Entity Type:Organization
Organization Name:FAVERO CHIROPRACTIC
Other - Org Name:FAVERO CHIROPRACTIC, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FAVERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-784-6306
Mailing Address - Street 1:365 E LOMOND VIEW DR # 102
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2269
Mailing Address - Country:US
Mailing Address - Phone:801-784-6306
Mailing Address - Fax:801-784-6316
Practice Address - Street 1:365 E LOMOND VIEW DR # 102
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-2269
Practice Address - Country:US
Practice Address - Phone:801-784-6306
Practice Address - Fax:801-784-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT83176191202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty