Provider Demographics
NPI:1780856278
Name:BASIC HEALTH CHIROPRACTIC LLC.
Entity type:Organization
Organization Name:BASIC HEALTH CHIROPRACTIC LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:LEMMON
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-465-8177
Mailing Address - Street 1:675 S 100 W STE 4
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2883
Mailing Address - Country:US
Mailing Address - Phone:801-465-8177
Mailing Address - Fax:801-465-8266
Practice Address - Street 1:675 S 100 W STE 4
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2883
Practice Address - Country:US
Practice Address - Phone:801-465-8177
Practice Address - Fax:801-465-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51637251202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty