Provider Demographics
NPI:1396204137
Name:RAINTREE CHIROPRACTIC & MASSAGE
Entity Type:Organization
Organization Name:RAINTREE CHIROPRACTIC & MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HETHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-560-1245
Mailing Address - Street 1:12180 S 300 E UNIT 1238
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-2654
Mailing Address - Country:US
Mailing Address - Phone:801-560-1245
Mailing Address - Fax:
Practice Address - Street 1:1962 E OAK SUMMIT DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5557
Practice Address - Country:US
Practice Address - Phone:801-560-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty