Provider Demographics
NPI:1396017745
Name:PINNACLE SPORTS & FAMILY WELLNESS
Entity Type:Organization
Organization Name:PINNACLE SPORTS & FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:SLEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-225-0992
Mailing Address - Street 1:PO BOX 13142
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84412-3142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:365 E LOMOND VIEW DR
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-2269
Practice Address - Country:US
Practice Address - Phone:385-244-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8185843-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty