Provider Demographics
NPI:1407273089
Name:EAST MILLCREEK CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:EAST MILLCREEK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-747-2447
Mailing Address - Street 1:4700 S 900 E
Mailing Address - Street 2:41G
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4959
Mailing Address - Country:US
Mailing Address - Phone:801-747-2447
Mailing Address - Fax:801-716-3532
Practice Address - Street 1:4700 SO 900 E
Practice Address - Street 2:41G
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4938
Practice Address - Country:US
Practice Address - Phone:801-747-2447
Practice Address - Fax:801-716-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8770385-1202111N00000X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty