Provider Demographics
NPI:1134563760
Name:JM GAURUDER LLC
Entity type:Organization
Organization Name:JM GAURUDER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GAURUDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-257-0106
Mailing Address - Street 1:805 W MAIN ST.
Mailing Address - Street 2:STE. C
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337
Mailing Address - Country:US
Mailing Address - Phone:435-257-0106
Mailing Address - Fax:435-257-0106
Practice Address - Street 1:805 W MAIN ST.
Practice Address - Street 2:SUITE C
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337
Practice Address - Country:US
Practice Address - Phone:435-257-0106
Practice Address - Fax:435-257-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7295235-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty