Provider Demographics
NPI:1558307140
Name:CHILD, JEFF W (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:W
Last Name:CHILD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 W 5200 S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3452
Mailing Address - Country:US
Mailing Address - Phone:801-525-0400
Mailing Address - Fax:
Practice Address - Street 1:1920 W 5200 S
Practice Address - Street 2:SUITE 5
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-3452
Practice Address - Country:US
Practice Address - Phone:801-525-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3705331202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor