Provider Demographics
NPI:1396718268
Name:FAIR, MYRON D (DC)
Entity type:Individual
Prefix:DR
First Name:MYRON
Middle Name:D
Last Name:FAIR
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 1:2421 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2420
Mailing Address - Country:US
Mailing Address - Phone:801-776-2800
Mailing Address - Fax:801-776-2725
Practice Address - Street 1:2421 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:UT
Practice Address - Zip Code:84015-2420
Practice Address - Country:US
Practice Address - Phone:801-776-2800
Practice Address - Fax:801-776-2725
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174286-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78089Medicare UPIN
UT00005618Medicare ID - Type Unspecified