Provider Demographics
NPI:1427014299
Name:WALBOM, JUSTIN LORENZ (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LORENZ
Last Name:WALBOM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9510
Mailing Address - Country:US
Mailing Address - Phone:801-492-6777
Mailing Address - Fax:801-770-2034
Practice Address - Street 1:10941 N ALPINE HWY
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8880
Practice Address - Country:US
Practice Address - Phone:801-492-6777
Practice Address - Fax:801-770-2034
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6110731-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor