Provider Demographics
NPI:1649704032
Name:LAYTON CHIROPRACTIC & ACCIDENT REHABILITATION
Entity type:Organization
Organization Name:LAYTON CHIROPRACTIC & ACCIDENT REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SARCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-784-7104
Mailing Address - Street 1:872 HERITAGE PARK BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5714
Mailing Address - Country:US
Mailing Address - Phone:801-784-7104
Mailing Address - Fax:
Practice Address - Street 1:872 HERITAGE PARK BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5714
Practice Address - Country:US
Practice Address - Phone:801-784-7104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE MOON HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8547239-1202261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation