Provider Demographics
NPI:1821328196
Name:WHOLE BODY HEALTH & DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:WHOLE BODY HEALTH & DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:TISCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-712-9183
Mailing Address - Street 1:1360 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5336
Mailing Address - Country:US
Mailing Address - Phone:801-712-9183
Mailing Address - Fax:801-931-2793
Practice Address - Street 1:1360 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5336
Practice Address - Country:US
Practice Address - Phone:801-712-9183
Practice Address - Fax:801-931-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7448212-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty