Provider Demographics
NPI:1669044715
Name:DIETZ, TAYLOR (DC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:DIETZ
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 1:1028 WEST 950 N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:85047
Mailing Address - Country:US
Mailing Address - Phone:801-769-6570
Mailing Address - Fax:888-505-3765
Practice Address - Street 1:1028 WEST 950 N
Practice Address - Street 2:SUITE 103
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:85047
Practice Address - Country:US
Practice Address - Phone:801-769-6570
Practice Address - Fax:888-505-3765
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8850911-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor