Provider Demographics
NPI:1124192042
Name:HEATH, DALE HARLAND (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:HARLAND
Last Name:HEATH
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 1:792 S 400 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-6322
Mailing Address - Country:US
Mailing Address - Phone:801-226-3383
Mailing Address - Fax:801-226-3224
Practice Address - Street 1:792 S 400 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-6322
Practice Address - Country:US
Practice Address - Phone:801-226-3383
Practice Address - Fax:801-226-3224
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2935441202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056121Medicare ID - Type Unspecified