Provider Demographics
NPI:1356820609
Name:WADSWORTH, JARED (DC, MS)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 N UNIVERSITY PKWY STE 6B
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1584
Mailing Address - Country:US
Mailing Address - Phone:801-235-9944
Mailing Address - Fax:801-235-9955
Practice Address - Street 1:2230 N UNIVERSITY PKWY #6B
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-8460
Practice Address - Country:US
Practice Address - Phone:801-235-9944
Practice Address - Fax:801-235-9955
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10320622-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician