Provider Demographics
NPI:1760690465
Name:SPORTS & FAMILY CHIROPRACTIC GROUP PC
Entity Type:Organization
Organization Name:SPORTS & FAMILY CHIROPRACTIC GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DUWAYNE
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-723-2311
Mailing Address - Street 1:990 MEDICAL DR STE UL-1
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4713
Mailing Address - Country:US
Mailing Address - Phone:435-723-2377
Mailing Address - Fax:435-723-9706
Practice Address - Street 1:990 MEDICAL DR STE UL-1
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-4713
Practice Address - Country:US
Practice Address - Phone:435-723-2377
Practice Address - Fax:435-723-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty