Provider Demographics
NPI:1679985576
Name:FORD FAMILY CHIROPRACTIC AND REJUVENATION CENTER
Entity Type:Organization
Organization Name:FORD FAMILY CHIROPRACTIC AND REJUVENATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-546-0114
Mailing Address - Street 1:101 N FORT LN
Mailing Address - Street 2:STE.101
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5682
Mailing Address - Country:US
Mailing Address - Phone:801-546-0114
Mailing Address - Fax:801-546-6915
Practice Address - Street 1:101 N FORT LN
Practice Address - Street 2:STE.101
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5682
Practice Address - Country:US
Practice Address - Phone:801-546-0114
Practice Address - Fax:801-546-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8062892-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty