Provider Demographics
NPI:1265714356
Name:UPPER CERVICAL CHIROPRACTIC OF UTAH
Entity type:Organization
Organization Name:UPPER CERVICAL CHIROPRACTIC OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-224-1121
Mailing Address - Street 1:239 W 520 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4696
Mailing Address - Country:US
Mailing Address - Phone:801-224-1121
Mailing Address - Fax:801-224-7151
Practice Address - Street 1:239 W 520 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4696
Practice Address - Country:US
Practice Address - Phone:801-224-1121
Practice Address - Fax:801-224-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT80411041202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center