Provider Demographics
NPI:1588800841
Name:BATEMAN CHIROPRACTIC AND PHYSIOTHERAPY LLC
Entity Type:Organization
Organization Name:BATEMAN CHIROPRACTIC AND PHYSIOTHERAPY LLC
Other - Org Name:BATEMAN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:J
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-302-9680
Mailing Address - Street 1:1654 REUNION AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4676
Mailing Address - Country:US
Mailing Address - Phone:801-302-9680
Mailing Address - Fax:
Practice Address - Street 1:1654 REUNION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4676
Practice Address - Country:US
Practice Address - Phone:801-302-9680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51215701202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty