Provider Demographics
NPI:1790259828
Name:UTAH CHIROPRACTIC AND REHAB
Entity Type:Organization
Organization Name:UTAH CHIROPRACTIC AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-762-7009
Mailing Address - Street 1:321 E 300 N STE B
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1790
Mailing Address - Country:US
Mailing Address - Phone:801-692-3231
Mailing Address - Fax:801-820-2860
Practice Address - Street 1:321 E 300 N STE B
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1790
Practice Address - Country:US
Practice Address - Phone:801-692-3231
Practice Address - Fax:801-820-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790042653OtherNPI