Provider Demographics
NPI:1184618514
Name:MAYER CHIROPRACTIC AND WELLNESS PC
Entity type:Organization
Organization Name:MAYER CHIROPRACTIC AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-773-8880
Mailing Address - Street 1:926 W 1700 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8530
Mailing Address - Country:US
Mailing Address - Phone:801-775-8880
Mailing Address - Fax:801-775-8890
Practice Address - Street 1:926 W 1700 S
Practice Address - Street 2:SUITE B
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-8530
Practice Address - Country:US
Practice Address - Phone:801-775-8880
Practice Address - Fax:801-775-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48735991202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528515844001Medicaid
UT528515844001Medicaid