Provider Demographics
NPI:1285230904
Name:AWAKEN HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:AWAKEN HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-505-9054
Mailing Address - Street 1:10661 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4108
Mailing Address - Country:US
Mailing Address - Phone:801-505-9054
Mailing Address - Fax:801-890-0408
Practice Address - Street 1:10661 S STATE ST
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4108
Practice Address - Country:US
Practice Address - Phone:801-505-9054
Practice Address - Fax:801-890-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty