Provider Demographics
NPI:1265754196
Name:ELMORE CHIROPRACTIC & NUTRITION, LC
Entity type:Organization
Organization Name:ELMORE CHIROPRACTIC & NUTRITION, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-774-7540
Mailing Address - Street 1:1842SOUTH 2000 WEST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9626
Mailing Address - Country:US
Mailing Address - Phone:801-774-7540
Mailing Address - Fax:801-774-7542
Practice Address - Street 1:1842 S 2000 W
Practice Address - Street 2:SUITE 2
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9626
Practice Address - Country:US
Practice Address - Phone:801-774-7540
Practice Address - Fax:801-774-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty