Provider Demographics
NPI:1477081412
Name:ALTA CANYON SPINE LLC
Entity Type:Organization
Organization Name:ALTA CANYON SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:BURNELL
Authorized Official - Last Name:HOHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-314-2225
Mailing Address - Street 1:5770 S 250 E STE 135
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8241
Mailing Address - Country:US
Mailing Address - Phone:801-314-2225
Mailing Address - Fax:801-314-2345
Practice Address - Street 1:5770 S 250 E STE 135
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-8241
Practice Address - Country:US
Practice Address - Phone:801-314-2225
Practice Address - Fax:801-314-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-02
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1639371149OtherNPI