Provider Demographics
NPI:1235437898
Name:JEFFREY P WHEELER D C INC
Entity Type:Organization
Organization Name:JEFFREY P WHEELER D C INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-392-2612
Mailing Address - Street 1:2483 HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2831
Mailing Address - Country:US
Mailing Address - Phone:801-392-2612
Mailing Address - Fax:801-393-1377
Practice Address - Street 1:2483 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2831
Practice Address - Country:US
Practice Address - Phone:801-392-2612
Practice Address - Fax:801-393-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT163472-1202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8703955510005Medicaid
UT000006082Medicare PIN
UTT48908Medicare UPIN