Provider Demographics
NPI:1477746485
Name:DYNAMIC HEALTH CARE OF UTAH LLC
Entity Type:Organization
Organization Name:DYNAMIC HEALTH CARE OF UTAH LLC
Other - Org Name:LOWRY HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-756-3888
Mailing Address - Street 1:559 W STATE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2111
Mailing Address - Country:US
Mailing Address - Phone:801-756-3888
Mailing Address - Fax:801-471-2777
Practice Address - Street 1:559 W STATE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2111
Practice Address - Country:US
Practice Address - Phone:801-756-3888
Practice Address - Fax:801-471-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5017692-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU82252Medicare UPIN
UT005754301Medicare PIN