Provider Demographics
NPI:1891860789
Name:COLARUSSO, JOHN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:COLARUSSO
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 1:12571 S PASTURE ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7037
Mailing Address - Country:US
Mailing Address - Phone:801-878-3645
Mailing Address - Fax:801-878-3647
Practice Address - Street 1:12571 S PASTURE ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7037
Practice Address - Country:US
Practice Address - Phone:801-878-3645
Practice Address - Fax:801-878-3647
Is Sole Proprietor?:No
Enumeration Date:2006-11-23
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5072634-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000061848OtherMEDICARE GROUP PTAN
UT000061847Medicare PIN