Provider Demographics
NPI:1851548283
Name:GALEN C. BIRDSLEY P.C.
Entity Type:Organization
Organization Name:GALEN C. BIRDSLEY P.C.
Other - Org Name:BIRDSLEY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BIRDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-467-7141
Mailing Address - Street 1:1360 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5336
Mailing Address - Country:US
Mailing Address - Phone:801-467-7141
Mailing Address - Fax:801-467-7246
Practice Address - Street 1:1360 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5336
Practice Address - Country:US
Practice Address - Phone:801-467-7141
Practice Address - Fax:801-467-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1618131202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000005719Medicare PIN