Provider Demographics
NPI:1689740250
Name:OGDEN, JON DAVID
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DAVID
Last Name:OGDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:D
Other - Last Name:OGDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2698
Mailing Address - Country:US
Mailing Address - Phone:435-896-5300
Mailing Address - Fax:
Practice Address - Street 1:3 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2698
Practice Address - Country:US
Practice Address - Phone:435-896-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4712584OtherCIGNA LOVELACE
NM77460OtherPRESBYTERIAN
NMNM00KK65OtherBLUE CROSS BLUE SHIELD
NM77460OtherPRESBYTERIAN
NM492843Medicare UPIN
NMNM00KK65OtherBLUE CROSS BLUE SHIELD