Provider Demographics
NPI:1922279736
Name:ALTA VIEW CHIROPRACTIC
Entity Type:Organization
Organization Name:ALTA VIEW CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-523-3898
Mailing Address - Street 1:1025 E 11400 S
Mailing Address - Street 2:STE. 104
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6942
Mailing Address - Country:US
Mailing Address - Phone:801-523-3898
Mailing Address - Fax:
Practice Address - Street 1:1025 E 11400 S
Practice Address - Street 2:STE. 104
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-6942
Practice Address - Country:US
Practice Address - Phone:801-523-3898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5636714-1202261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service