Provider Demographics
NPI:1265452163
Name:FAUST, DAMON MONSON (DC)
Entity type:Individual
Prefix:DR
First Name:DAMON
Middle Name:MONSON
Last Name:FAUST
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 1:1675 N FREEDOM BLVD
Mailing Address - Street 2:7A
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2540
Mailing Address - Country:US
Mailing Address - Phone:801-489-1075
Mailing Address - Fax:
Practice Address - Street 1:1675 N FREEDOM BLVD
Practice Address - Street 2:7A
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2540
Practice Address - Country:US
Practice Address - Phone:801-489-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1761501202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870395551005Medicaid
UT870395551005Medicaid