Provider Demographics
NPI:1508980350
Name:J C ENTERPRISES INC
Entity Type:Organization
Organization Name:J C ENTERPRISES INC
Other - Org Name:COMFORTWALKER SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-466-9444
Mailing Address - Street 1:2330 SO MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115
Mailing Address - Country:US
Mailing Address - Phone:801-466-9444
Mailing Address - Fax:
Practice Address - Street 1:2330 SO MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115
Practice Address - Country:US
Practice Address - Phone:801-466-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========002Medicaid
UT=========002Medicaid