Provider Demographics
NPI:1689835167
Name:MARK VOSTI
Entity Type:Organization
Organization Name:MARK VOSTI
Other - Org Name:SOUTH MOUNTAIN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:V
Authorized Official - Last Name:VOSTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-619-6090
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-0650
Mailing Address - Country:US
Mailing Address - Phone:801-619-6090
Mailing Address - Fax:801-748-0604
Practice Address - Street 1:1101 E DRAPER PKWY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9096
Practice Address - Country:US
Practice Address - Phone:801-619-6090
Practice Address - Fax:801-748-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2774298-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000058111Medicare PIN