Provider Demographics
NPI:1215377460
Name:NEUROBOLIC HEALTH CENTER
Entity Type:Organization
Organization Name:NEUROBOLIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-495-4444
Mailing Address - Street 1:1664 W 10600 S STE 4
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8611
Mailing Address - Country:US
Mailing Address - Phone:801-495-4444
Mailing Address - Fax:801-446-5351
Practice Address - Street 1:1664 W 10600 S STE 4
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8611
Practice Address - Country:US
Practice Address - Phone:801-495-4444
Practice Address - Fax:801-446-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT336524-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty