Provider Demographics
NPI:1417042474
Name:NORTH COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:NORTH COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-653-2800
Mailing Address - Street 1:680 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1656
Mailing Address - Country:US
Mailing Address - Phone:801-653-2800
Mailing Address - Fax:801-653-2521
Practice Address - Street 1:680 E STATE ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1656
Practice Address - Country:US
Practice Address - Phone:801-653-2800
Practice Address - Fax:801-653-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT63251540160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty