Provider Demographics
NPI:1558416453
Name:DOCERE CLINIC
Entity Type:Organization
Organization Name:DOCERE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:801-582-3260
Mailing Address - Street 1:2188 SOUTH HIGHLAND DRIVE
Mailing Address - Street 2:STE. 210
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106
Mailing Address - Country:US
Mailing Address - Phone:801-582-3260
Mailing Address - Fax:801-484-2606
Practice Address - Street 1:2188 SOUTH HIGHLAND DRIVE
Practice Address - Street 2:STE. 210
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-582-3260
Practice Address - Fax:801-484-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5160749-7100175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty