Provider Demographics
NPI:1447400114
Name:HIGH FIVE CHIROPRACTIC
Entity Type:Organization
Organization Name:HIGH FIVE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-636-7499
Mailing Address - Street 1:456 NORTH S.R. 198
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653
Mailing Address - Country:US
Mailing Address - Phone:801-423-3555
Mailing Address - Fax:801-423-2855
Practice Address - Street 1:456 STATE ROAD 198
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-9187
Practice Address - Country:US
Practice Address - Phone:801-423-3555
Practice Address - Fax:801-423-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT71183171202261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service