Provider Demographics
NPI:1265068472
Name:CANYONLANDS NATURAL MEDICINE
Entity type:Organization
Organization Name:CANYONLANDS NATURAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:801-441-0549
Mailing Address - Street 1:1174 S FOOTHILL DR APT 433
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1958
Mailing Address - Country:US
Mailing Address - Phone:920-273-5565
Mailing Address - Fax:
Practice Address - Street 1:1817 S MAIN ST STE 13
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-7051
Practice Address - Country:US
Practice Address - Phone:801-441-0549
Practice Address - Fax:801-901-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1891246922OtherNPI
UT1811439987OtherNPI