Provider Demographics
NPI:1376678268
Name:PRESTON FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:PRESTON FAMILY CHIROPRACTIC
Other - Org Name:GONSTEAD FAMILY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-612-1085
Mailing Address - Street 1:745 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4953
Mailing Address - Country:US
Mailing Address - Phone:801-612-1085
Mailing Address - Fax:801-337-1104
Practice Address - Street 1:745 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-4953
Practice Address - Country:US
Practice Address - Phone:801-612-1085
Practice Address - Fax:801-337-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4948089120251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage