Provider Demographics
NPI:1972781755
Name:CLEVERLEY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CLEVERLEY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:CLEVERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-562-0363
Mailing Address - Street 1:1684 W REUNION AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4626
Mailing Address - Country:US
Mailing Address - Phone:801-562-0363
Mailing Address - Fax:801-562-0347
Practice Address - Street 1:1684 W REUNION AVE STE 250
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4626
Practice Address - Country:US
Practice Address - Phone:801-562-0363
Practice Address - Fax:801-562-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty