Provider Demographics
NPI:1033085113
Name:SPINE CRAFT UTAH LLC
Entity type:Organization
Organization Name:SPINE CRAFT UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:907-382-6701
Mailing Address - Street 1:1807 N 1120 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1180
Mailing Address - Country:US
Mailing Address - Phone:385-442-2225
Mailing Address - Fax:385-442-2226
Practice Address - Street 1:1807 N 1120 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1180
Practice Address - Country:US
Practice Address - Phone:385-442-2225
Practice Address - Fax:385-442-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty