Provider Demographics
NPI:1528219060
Name:DR BRIAN MUTO ENTERPRISES
Entity Type:Organization
Organization Name:DR BRIAN MUTO ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-523-8755
Mailing Address - Street 1:11483 S STATE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9403
Mailing Address - Country:US
Mailing Address - Phone:801-523-8755
Mailing Address - Fax:801-523-8405
Practice Address - Street 1:11483 S STATE ST
Practice Address - Street 2:SUITE F
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9403
Practice Address - Country:US
Practice Address - Phone:801-523-8755
Practice Address - Fax:801-523-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6563914-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty