Provider Demographics
NPI:1801028311
Name:CROSSCOUNTRY HEALTH,, P.C.
Entity Type:Organization
Organization Name:CROSSCOUNTRY HEALTH,, P.C.
Other - Org Name:OGDEN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/ CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KOCOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-612-1085
Mailing Address - Street 1:745 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4953
Mailing Address - Country:US
Mailing Address - Phone:801-612-1085
Mailing Address - Fax:801-337-1104
Practice Address - Street 1:745 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-4953
Practice Address - Country:US
Practice Address - Phone:801-612-1085
Practice Address - Fax:801-337-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7387084-1202111N00000X
UT7387085-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty