Provider Demographics
NPI:1245302413
Name:WHEELWRIGHT, JEFFERY ALLYN (DC)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ALLYN
Last Name:WHEELWRIGHT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 W OLD HIGHWAY RD
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1590 W OLD HIGHWAY RD
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9301
Practice Address - Country:US
Practice Address - Phone:801-829-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT336108-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005795501Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
UTU64882Medicare UPIN
UT000057955Medicare ID - Type UnspecifiedMEDICARE GROUP #