Provider Demographics
NPI:1417548389
Name:LOGAN CANYON CO LLC
Entity Type:Organization
Organization Name:LOGAN CANYON CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-710-0577
Mailing Address - Street 1:6308 MONROVIA ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2740
Mailing Address - Country:US
Mailing Address - Phone:913-710-0577
Mailing Address - Fax:913-962-1627
Practice Address - Street 1:6308 MONROVIA ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-2740
Practice Address - Country:US
Practice Address - Phone:913-710-0577
Practice Address - Fax:913-962-1627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOGAN CANYON CO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty