Provider Demographics
NPI:1154077832
Name:ALPHA CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:ALPHA CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-601-1239
Mailing Address - Street 1:2195 W 5400 S STE 105
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-1433
Mailing Address - Country:US
Mailing Address - Phone:801-601-1239
Mailing Address - Fax:385-900-5288
Practice Address - Street 1:2195 W 5400 S STE 105
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1433
Practice Address - Country:US
Practice Address - Phone:801-601-1239
Practice Address - Fax:385-900-5288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty