Provider Demographics
NPI:1013242569
Name:VERRE, JUSTIN DENNIS (LAC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DENNIS
Last Name:VERRE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E 3RD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-4773
Mailing Address - Country:US
Mailing Address - Phone:801-835-8269
Mailing Address - Fax:
Practice Address - Street 1:4455 S 700 E STE 300
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84107-3076
Practice Address - Country:US
Practice Address - Phone:801-835-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU-1545171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist