Provider Demographics
NPI:1437362233
Name:AMON CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:AMON CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:AMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-731-2200
Mailing Address - Street 1:3996 S 1900 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3111
Mailing Address - Country:US
Mailing Address - Phone:801-731-2200
Mailing Address - Fax:801-731-2228
Practice Address - Street 1:3996 S 1900 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-3111
Practice Address - Country:US
Practice Address - Phone:801-731-2200
Practice Address - Fax:801-731-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171663-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT465046244001 D6695Medicaid
UTPERSON NPI NUMBEROther1265407282