Provider Demographics
NPI:1265632319
Name:INTERMOUNTAIN MOTION X-RAY
Entity Type:Organization
Organization Name:INTERMOUNTAIN MOTION X-RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VELOY
Authorized Official - Middle Name:K
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-798-6558
Mailing Address - Street 1:642 KIRBY LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5505
Mailing Address - Country:US
Mailing Address - Phone:801-798-6558
Mailing Address - Fax:801-798-3690
Practice Address - Street 1:642 KIRBY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-5505
Practice Address - Country:US
Practice Address - Phone:801-798-6558
Practice Address - Fax:801-798-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51284901202111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty