Provider Demographics
NPI:1841781572
Name:BIRD, STEVEN KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KENNETH
Last Name:BIRD
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 1:741 W SMELTER ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7111
Mailing Address - Country:US
Mailing Address - Phone:801-251-6658
Mailing Address - Fax:
Practice Address - Street 1:741 W SMELTER ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-7111
Practice Address - Country:US
Practice Address - Phone:801-251-6658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10837012-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT82-5477606Medicaid