Provider Demographics
NPI:1588847909
Name:STERLING BLACK, LLC
Entity Type:Organization
Organization Name:STERLING BLACK, LLC
Other - Org Name:SAN JUAN CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-678-2795
Mailing Address - Street 1:792 S MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511
Mailing Address - Country:US
Mailing Address - Phone:435-678-2795
Mailing Address - Fax:
Practice Address - Street 1:792 S MAIN ST.
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511
Practice Address - Country:US
Practice Address - Phone:435-678-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty