Provider Demographics
NPI:1750815262
Name:STAYFITWELLNESS CLINIC
Entity Type:Organization
Organization Name:STAYFITWELLNESS CLINIC
Other - Org Name:STAYFIT WELLNESS CLINIC, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER/PART OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBINETTE
Authorized Official - Middle Name:EVANGELINE
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:801-690-3552
Mailing Address - Street 1:116 N ADAMSWOOD RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-4004
Mailing Address - Country:US
Mailing Address - Phone:801-888-2134
Mailing Address - Fax:801-546-2502
Practice Address - Street 1:1012 E MUTTON HOLLOW RD
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1241
Practice Address - Country:US
Practice Address - Phone:801-690-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1729551202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty