Provider Demographics
NPI:1871817940
Name:ROCKY MOUNTAIN WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN WELLNESS CENTER, LLC
Other - Org Name:ROCKY MOUNTAIN FAMILY CHIROPRACTIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-683-9553
Mailing Address - Street 1:780 S 2000 W
Mailing Address - Street 2:BLDG A, STE. 101
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9602
Mailing Address - Country:US
Mailing Address - Phone:801-683-9553
Mailing Address - Fax:855-326-1581
Practice Address - Street 1:780 S 2000 W
Practice Address - Street 2:BLDG A, STE. 101
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9602
Practice Address - Country:US
Practice Address - Phone:801-683-9553
Practice Address - Fax:855-326-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7212527-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty