Provider Demographics
NPI:1659141190
Name:HUNTSMAN SPINAL CLINIC INC
Entity Type:Organization
Organization Name:HUNTSMAN SPINAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KADE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUNTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-414-7420
Mailing Address - Street 1:1220 E 3900 S STE 3G
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1326
Mailing Address - Country:US
Mailing Address - Phone:801-346-7788
Mailing Address - Fax:
Practice Address - Street 1:1220 E 3900 S STE 3G
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1326
Practice Address - Country:US
Practice Address - Phone:801-346-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty