Provider Demographics
NPI:1205437548
Name:LOGAN, CORDELL E (ND)
Entity type:Individual
Prefix:
First Name:CORDELL
Middle Name:E
Last Name:LOGAN
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1994 W CARRIAGE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-5748
Mailing Address - Country:US
Mailing Address - Phone:801-708-9076
Mailing Address - Fax:
Practice Address - Street 1:126 W 12300 S STE C
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9801
Practice Address - Country:US
Practice Address - Phone:385-237-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT100519-9932175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath