Provider Demographics
NPI:1578050175
Name:ARRIETA, OMAR (DC)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ARRIETA
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 1:6577 S GREENMEADOW WAY APT 10E
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2267
Mailing Address - Country:US
Mailing Address - Phone:904-910-9894
Mailing Address - Fax:
Practice Address - Street 1:141 E 5600 S STE 204
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8242
Practice Address - Country:US
Practice Address - Phone:801-905-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10764087-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty