Provider Demographics
NPI:1740836345
Name:THE LIFT CLINIC, LLC
Entity type:Organization
Organization Name:THE LIFT CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-699-8534
Mailing Address - Street 1:PO BOX 2625
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84110-2625
Mailing Address - Country:US
Mailing Address - Phone:801-996-7076
Mailing Address - Fax:
Practice Address - Street 1:345 W 100 S # 6C
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84101-1209
Practice Address - Country:US
Practice Address - Phone:801-996-7076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty