Provider Demographics
NPI:1841241338
Name:BACH, JOHN ADOLF (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ADOLF
Last Name:BACH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 S 600 E
Mailing Address - Street 2:
Mailing Address - City:S SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2062
Mailing Address - Country:US
Mailing Address - Phone:801-487-1010
Mailing Address - Fax:
Practice Address - Street 1:1473 S 600 E
Practice Address - Street 2:
Practice Address - City:S SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84105-2062
Practice Address - Country:US
Practice Address - Phone:801-487-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT170061-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor