Provider Demographics
NPI:1013052380
Name:DIRK S WOODMANSEE DC PC
Entity Type:Organization
Organization Name:DIRK S WOODMANSEE DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOODMANSEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-562-1531
Mailing Address - Street 1:2618 W 7800 S STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4213
Mailing Address - Country:US
Mailing Address - Phone:801-562-1531
Mailing Address - Fax:801-562-1534
Practice Address - Street 1:2618 W 7800 S STE 200
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4213
Practice Address - Country:US
Practice Address - Phone:801-562-1531
Practice Address - Fax:801-562-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT973507121202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT973507121202OtherUTAH STATE LIC.
UT973507121202OtherUTAH STATE LIC.