Provider Demographics
NPI:1700040292
Name:POPPE, JUSTIN KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:KEVIN
Last Name:POPPE
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 1:2232 S 1300 W
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7183
Mailing Address - Country:US
Mailing Address - Phone:435-773-3940
Mailing Address - Fax:435-674-2646
Practice Address - Street 1:720 S RIVER RD STE C240
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2103
Practice Address - Country:US
Practice Address - Phone:435-656-2888
Practice Address - Fax:435-656-8400
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6996342-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor