Provider Demographics
NPI:1427198779
Name:CROSSROADS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CROSSROADS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-773-7448
Mailing Address - Street 1:610 N MAIN ST STE 5A
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-3200
Mailing Address - Country:US
Mailing Address - Phone:801-773-7448
Mailing Address - Fax:801-773-7448
Practice Address - Street 1:610 N MAIN ST STE 5A
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-3200
Practice Address - Country:US
Practice Address - Phone:801-773-7448
Practice Address - Fax:801-773-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2775121202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty