Provider Demographics
NPI:1417089681
Name:CASCADE SPINAL REHAB CENTER LLC
Entity Type:Organization
Organization Name:CASCADE SPINAL REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:AUTHUR
Authorized Official - Last Name:BEUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-235-9977
Mailing Address - Street 1:75 S 200 E
Mailing Address - Street 2:STE 201
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3146
Mailing Address - Country:US
Mailing Address - Phone:801-235-9977
Mailing Address - Fax:801-235-0949
Practice Address - Street 1:75 S 200 E
Practice Address - Street 2:STE 201
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3146
Practice Address - Country:US
Practice Address - Phone:801-235-9977
Practice Address - Fax:801-235-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT353325-1202111N00000X
UT347121-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1649344490Medicare UPIN
UT000055957Medicare ID - Type Unspecified
UT1023184207Medicare UPIN
UT005595703Medicare ID - Type Unspecified
UT005595704Medicare ID - Type Unspecified