Provider Demographics
NPI:1164014908
Name:413 OGDEN CLINIC LLC
Entity Type:Organization
Organization Name:413 OGDEN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-FERRATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-651-4283
Mailing Address - Street 1:754 S 400 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-6342
Mailing Address - Country:US
Mailing Address - Phone:801-427-9770
Mailing Address - Fax:385-238-4166
Practice Address - Street 1:413 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-6320
Practice Address - Country:US
Practice Address - Phone:385-238-4123
Practice Address - Fax:385-238-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty