Provider Demographics
NPI:1194026914
Name:TEMPLE VIEW CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:TEMPLE VIEW CHIROPRACTIC CLINIC, INC
Other - Org Name:GREG W. KOFFORD, DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:W
Authorized Official - Last Name:KOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-756-8833
Mailing Address - Street 1:246 S 1100 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2829
Mailing Address - Country:US
Mailing Address - Phone:801-756-8833
Mailing Address - Fax:801-756-9014
Practice Address - Street 1:246 S 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2829
Practice Address - Country:US
Practice Address - Phone:801-756-8833
Practice Address - Fax:801-756-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363413 1202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT564570268002Medicaid
UT000056237Medicare PIN
UT564570268002Medicaid