Provider Demographics
NPI:1477048858
Name:HOMETOWN HEALTHCARE LLC
Entity Type:Organization
Organization Name:HOMETOWN HEALTHCARE LLC
Other - Org Name:HOMETOWN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRILL
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:801-504-6370
Mailing Address - Street 1:591 N STATE ROAD 198
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-5668
Mailing Address - Country:US
Mailing Address - Phone:801-504-6370
Mailing Address - Fax:801-504-6095
Practice Address - Street 1:591 N STATE ROAD 198
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-5668
Practice Address - Country:US
Practice Address - Phone:801-504-6370
Practice Address - Fax:801-504-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10250498-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty