Provider Demographics
NPI:1205957792
Name:NATUROPATHIC CHILDREN'S MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:NATUROPATHIC CHILDREN'S MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEGRAND
Authorized Official - Last Name:HUMPHERYS
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:801-565-3755
Mailing Address - Street 1:8537 REDWOOD RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9311
Mailing Address - Country:US
Mailing Address - Phone:801-565-3755
Mailing Address - Fax:801-565-7171
Practice Address - Street 1:8537 REDWOOD RD
Practice Address - Street 2:UNIT B
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9311
Practice Address - Country:US
Practice Address - Phone:801-565-3755
Practice Address - Fax:801-565-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6461348-7101175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty