Provider Demographics
NPI:1801908090
Name:CENTER FOR CHIROPRACTIC HEALTH CARE
Entity type:Organization
Organization Name:CENTER FOR CHIROPRACTIC HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-417-5700
Mailing Address - Street 1:5204 S REDWOOD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4217
Mailing Address - Country:US
Mailing Address - Phone:801-417-5700
Mailing Address - Fax:801-417-5702
Practice Address - Street 1:5204 S REDWOOD RD
Practice Address - Street 2:SUITE B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123
Practice Address - Country:US
Practice Address - Phone:801-417-5700
Practice Address - Fax:801-417-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52829301202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056378Medicare ID - Type Unspecified
UTU95066Medicare UPIN