Provider Demographics
NPI:1295155943
Name:MIRANDA, DAVID STUART (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STUART
Last Name:MIRANDA
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 1:251 E 1200 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6905
Mailing Address - Country:US
Mailing Address - Phone:305-763-6658
Mailing Address - Fax:
Practice Address - Street 1:251 E 1200 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6905
Practice Address - Country:US
Practice Address - Phone:801-900-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11153111N00000X
UT10790744-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor