Provider Demographics
NPI:1750987657
Name:CHALK WELLNESS PLLC
Entity type:Organization
Organization Name:CHALK WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHALK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-571-1338
Mailing Address - Street 1:4775 W DAYBREAK PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5139
Mailing Address - Country:US
Mailing Address - Phone:801-571-1338
Mailing Address - Fax:
Practice Address - Street 1:4775 W DAYBREAK PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5139
Practice Address - Country:US
Practice Address - Phone:801-571-1338
Practice Address - Fax:801-516-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center