Provider Demographics
NPI:1376680603
Name:CHIROPRACTIC MEDICINE
Entity Type:Organization
Organization Name:CHIROPRACTIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OVERSEER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MD
Authorized Official - Phone:801-974-5644
Mailing Address - Street 1:3646 S. REDWOOD RD,
Mailing Address - Street 2:SUITE W-1
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3646 S. REDWOOD RD,
Practice Address - Street 2:SUITE W-1
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119
Practice Address - Country:US
Practice Address - Phone:801-974-5644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176317-1202261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service