Provider Demographics
NPI:1013245521
Name:BRYON L. ROSQUIST DC PC
Entity Type:Organization
Organization Name:BRYON L. ROSQUIST DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-785-9411
Mailing Address - Street 1:405 S 100 E STE 104
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2751
Mailing Address - Country:US
Mailing Address - Phone:801-785-9411
Mailing Address - Fax:800-785-9417
Practice Address - Street 1:405 S 100 E STE 104
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2751
Practice Address - Country:US
Practice Address - Phone:801-785-9411
Practice Address - Fax:800-785-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT168454-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty