Provider Demographics
NPI:1376887927
Name:ERIC C CHENWORTH D O P C
Entity Type:Organization
Organization Name:ERIC C CHENWORTH D O P C
Other - Org Name:WASATCH ALLERGY AND ASTHMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:385-290-1289
Mailing Address - Street 1:24 S 1100 E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1500
Mailing Address - Country:US
Mailing Address - Phone:385-290-1289
Mailing Address - Fax:385-290-1290
Practice Address - Street 1:24 S 1100 E
Practice Address - Street 2:SUITE 201
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1500
Practice Address - Country:US
Practice Address - Phone:385-290-1289
Practice Address - Fax:385-290-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty