Provider Demographics
NPI:1821421983
Name:ERIC C. CHENWORTH, D.O.,P.C.
Entity Type:Organization
Organization Name:ERIC C. CHENWORTH, D.O.,P.C.
Other - Org Name:WASATCH ALLERGY AND ASTHMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHENWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:385-290-1289
Mailing Address - Street 1:24 S 1100 E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1500
Mailing Address - Country:US
Mailing Address - Phone:385-290-1289
Mailing Address - Fax:
Practice Address - Street 1:24 S 1100 E
Practice Address - Street 2:SUITE 201
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1500
Practice Address - Country:US
Practice Address - Phone:385-290-1289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7666176-1204207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty