Provider Demographics
NPI:1962818070
Name:DELTA CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:DELTA CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-864-1833
Mailing Address - Street 1:58 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-9500
Mailing Address - Country:US
Mailing Address - Phone:435-864-1833
Mailing Address - Fax:435-864-1833
Practice Address - Street 1:58 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-9500
Practice Address - Country:US
Practice Address - Phone:435-864-1833
Practice Address - Fax:435-864-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty