Provider Demographics
NPI:1831474550
Name:CANOVA CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CANOVA CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:CANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-726-2547
Mailing Address - Street 1:2922 W 1800 N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-7610
Mailing Address - Country:US
Mailing Address - Phone:801-776-3389
Mailing Address - Fax:801-775-9393
Practice Address - Street 1:610 N MAIN ST # 5B
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-3200
Practice Address - Country:US
Practice Address - Phone:801-776-3389
Practice Address - Fax:801-775-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT269016-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056175Medicare PIN