Provider Demographics
NPI:1871681288
Name:ATKINSON, RAYMOND DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DOUGLAS
Last Name:ATKINSON
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 1:732 APPLE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3661
Mailing Address - Country:US
Mailing Address - Phone:801-785-0284
Mailing Address - Fax:801-785-9417
Practice Address - Street 1:895 N 900 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-9183
Practice Address - Country:US
Practice Address - Phone:801-785-0284
Practice Address - Fax:801-785-9417
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5082095-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT609157Medicare ID - Type Unspecified
UTU62096Medicare UPIN