Provider Demographics
NPI:1700924107
Name:HOWARD, JERRY L (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:HOWARD
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 1:175 W 900 S STE 6
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5269
Mailing Address - Country:US
Mailing Address - Phone:435-688-7888
Mailing Address - Fax:435-652-1972
Practice Address - Street 1:175 W 900 S STE 6
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5269
Practice Address - Country:US
Practice Address - Phone:435-688-7888
Practice Address - Fax:435-652-1972
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT352673-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056341Medicare ID - Type UnspecifiedPROVIDER NUMBER