Provider Demographics
NPI:1134409063
Name:ALTA VIEW HEALTH & WELLNESS
Entity type:Organization
Organization Name:ALTA VIEW HEALTH & WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-523-3898
Mailing Address - Street 1:1551 SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5004
Mailing Address - Country:US
Mailing Address - Phone:801-523-3898
Mailing Address - Fax:801-692-9127
Practice Address - Street 1:9844 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4673
Practice Address - Country:US
Practice Address - Phone:801-523-3898
Practice Address - Fax:801-692-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5636714-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty