Provider Demographics
NPI:1528365566
Name:COPPERWELL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COPPERWELL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-253-8141
Mailing Address - Street 1:5069 W 13400 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6601
Mailing Address - Country:US
Mailing Address - Phone:801-253-8141
Mailing Address - Fax:801-253-2940
Practice Address - Street 1:5069 W 13400 S
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6601
Practice Address - Country:US
Practice Address - Phone:801-253-8141
Practice Address - Fax:801-253-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7861490-1202111N00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty