Provider Demographics
NPI:1366656613
Name:PEAK WELLNESS INC
Entity Type:Organization
Organization Name:PEAK WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:DUGGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-677-7878
Mailing Address - Street 1:544 WEST 750 SOUTH
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7267
Mailing Address - Country:US
Mailing Address - Phone:801-677-7878
Mailing Address - Fax:801-298-1435
Practice Address - Street 1:544 WEST 750 SOUTH
Practice Address - Street 2:SUITE D
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7267
Practice Address - Country:US
Practice Address - Phone:801-677-7878
Practice Address - Fax:801-298-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3684641201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty