Provider Demographics
NPI:1619078748
Name:CHIROPRACTIC PLACE LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-268-8051
Mailing Address - Street 1:6717 S 900 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5754
Mailing Address - Country:US
Mailing Address - Phone:801-432-7511
Mailing Address - Fax:801-432-7516
Practice Address - Street 1:6717 S 900 E
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5754
Practice Address - Country:US
Practice Address - Phone:801-432-7511
Practice Address - Fax:801-432-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT335099-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8703955551005Medicaid
UT8703955551005Medicaid