Provider Demographics
NPI:1255768438
Name:VALLEY CHIROPRACTIC & WELLNESS LLC
Entity type:Organization
Organization Name:VALLEY CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:IDSINGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-894-9633
Mailing Address - Street 1:663 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1144
Mailing Address - Country:US
Mailing Address - Phone:801-894-9633
Mailing Address - Fax:801-386-5634
Practice Address - Street 1:663 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1144
Practice Address - Country:US
Practice Address - Phone:801-894-9633
Practice Address - Fax:801-386-5634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8530109-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty