Provider Demographics
NPI:1275229338
Name:SUMMIT FAMILY CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:SUMMIT FAMILY CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KERCHER
Authorized Official - Last Name:GLASGOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-702-0386
Mailing Address - Street 1:12058 S TUSCANY CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6117
Mailing Address - Country:US
Mailing Address - Phone:801-702-0386
Mailing Address - Fax:
Practice Address - Street 1:12397 S 300 E STE 200
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8274
Practice Address - Country:US
Practice Address - Phone:385-351-4665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty