Provider Demographics
NPI:1598069627
Name:CONNECT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CONNECT CHIROPRACTIC LLC
Other - Org Name:HADERLIE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HADERLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-768-2939
Mailing Address - Street 1:380 E MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2228
Mailing Address - Country:US
Mailing Address - Phone:801-768-2939
Mailing Address - Fax:801-768-2955
Practice Address - Street 1:380 E MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2228
Practice Address - Country:US
Practice Address - Phone:801-768-2939
Practice Address - Fax:801-768-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7059633-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty