Provider Demographics
NPI:1134473267
Name:ADVANCED INJURY REHABILITATION, LLC
Entity Type:Organization
Organization Name:ADVANCED INJURY REHABILITATION, LLC
Other - Org Name:PIONEER CHIROPRACTIC WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-317-4757
Mailing Address - Street 1:1920 W 250 N
Mailing Address - Street 2:STE 24
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9233
Mailing Address - Country:US
Mailing Address - Phone:801-317-4757
Mailing Address - Fax:801-605-3439
Practice Address - Street 1:1920 W 250 N
Practice Address - Street 2:STE 24
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-9233
Practice Address - Country:US
Practice Address - Phone:801-317-4757
Practice Address - Fax:801-605-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294900-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty