Provider Demographics
NPI:1619953254
Name:WHEELER, STEPHEN MARK (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5974 FASHION POINT DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4699
Mailing Address - Country:US
Mailing Address - Phone:801-621-1667
Mailing Address - Fax:801-475-6802
Practice Address - Street 1:5974 FASHION POINT DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4699
Practice Address - Country:US
Practice Address - Phone:801-621-1667
Practice Address - Fax:801-475-6802
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2903031202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT204574521OtherTAX IDENTIFICATION NUMBER
UT204574521OtherTAX IDENTIFICATION NUMBER
UTU74311Medicare UPIN