Provider Demographics
NPI:1942962212
Name:SANTLIV
Entity Type:Organization
Organization Name:SANTLIV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-774-5424
Mailing Address - Street 1:1734 W BRIDGE POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5040
Mailing Address - Country:US
Mailing Address - Phone:435-774-5424
Mailing Address - Fax:
Practice Address - Street 1:1734 W BRIDGE POINTE WAY
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5040
Practice Address - Country:US
Practice Address - Phone:435-774-5424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTLIV
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty