Provider Demographics
NPI:1508163189
Name:BOND CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BOND CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-562-0363
Mailing Address - Street 1:1684 REUNION AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4608
Mailing Address - Country:US
Mailing Address - Phone:801-562-0363
Mailing Address - Fax:801-562-0347
Practice Address - Street 1:1684 REUNION AVE
Practice Address - Street 2:STE 250
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4608
Practice Address - Country:US
Practice Address - Phone:801-562-0363
Practice Address - Fax:801-562-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT175401-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000005862Medicare UPIN