Provider Demographics
NPI:1740744101
Name:DRD ENTERPRISES, LLC
Entity Type:Organization
Organization Name:DRD ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-864-8881
Mailing Address - Street 1:7186 S HIGHLAND DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7324
Mailing Address - Country:US
Mailing Address - Phone:801-942-0069
Mailing Address - Fax:801-619-2085
Practice Address - Street 1:7186 S HIGHLAND DR STE 150
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-7324
Practice Address - Country:US
Practice Address - Phone:801-942-0069
Practice Address - Fax:801-619-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty