Provider Demographics
NPI:1760789374
Name:RIVERTON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:RIVERTON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:801-688-3693
Mailing Address - Street 1:3409 W 12600 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7260
Mailing Address - Country:US
Mailing Address - Phone:801-750-0901
Mailing Address - Fax:
Practice Address - Street 1:3409 W 12600 S
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7260
Practice Address - Country:US
Practice Address - Phone:801-750-0901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7845949-1202261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service