Provider Demographics
NPI:1821391939
Name:SOUTH VALLEY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SOUTH VALLEY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-571-3333
Mailing Address - Street 1:834 E 9400 S STE 57
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4105
Mailing Address - Country:US
Mailing Address - Phone:801-571-3333
Mailing Address - Fax:801-571-4449
Practice Address - Street 1:834 E 9400 S STE 57
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4105
Practice Address - Country:US
Practice Address - Phone:801-571-3333
Practice Address - Fax:801-571-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT173704-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty