Provider Demographics
NPI:1780855635
Name:MAYER, BRENT JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JAMES
Last Name:MAYER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 W 1700 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8530
Mailing Address - Country:US
Mailing Address - Phone:801-775-8880
Mailing Address - Fax:801-775-8890
Practice Address - Street 1:926 W 1700 S
Practice Address - Street 2:SUITE B
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-8530
Practice Address - Country:US
Practice Address - Phone:801-775-8880
Practice Address - Fax:801-775-8890
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48735991202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU90027Medicare UPIN