Provider Demographics
NPI:1598016271
Name:ST GEORGE PURE HEALTH AND WELLSNESS INC
Entity Type:Organization
Organization Name:ST GEORGE PURE HEALTH AND WELLSNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:JESSOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-862-0125
Mailing Address - Street 1:491 E RIVERSIDE DR
Mailing Address - Street 2:STE 4B
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7051
Mailing Address - Country:US
Mailing Address - Phone:435-862-0125
Mailing Address - Fax:888-370-4198
Practice Address - Street 1:491 E RIVERSIDE DR
Practice Address - Street 2:STE 4B
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7051
Practice Address - Country:US
Practice Address - Phone:435-862-0125
Practice Address - Fax:888-370-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty