Provider Demographics
NPI:1255746400
Name:CAMP4 HUMAN PERFORMANCE
Entity type:Organization
Organization Name:CAMP4 HUMAN PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-878-7356
Mailing Address - Street 1:1951 W 4700 S STE 2
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-1108
Mailing Address - Country:US
Mailing Address - Phone:801-878-7356
Mailing Address - Fax:801-878-7436
Practice Address - Street 1:1951 W 4700 S STE 2
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1108
Practice Address - Country:US
Practice Address - Phone:801-878-7356
Practice Address - Fax:801-878-7436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty