Provider Demographics
NPI:1710685516
Name:GAUDIUM VITAE LLC
Entity Type:Organization
Organization Name:GAUDIUM VITAE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-840-4615
Mailing Address - Street 1:7831 S HIGHLANDPOINT WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-6049
Mailing Address - Country:US
Mailing Address - Phone:435-840-4615
Mailing Address - Fax:
Practice Address - Street 1:5481 W 7800 S STE 110
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-6027
Practice Address - Country:US
Practice Address - Phone:435-562-1513
Practice Address - Fax:435-562-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty