Provider Demographics
NPI:1811528987
Name:GREAT WESTERN CHIROPRACTIC MANAGEMENT SERVICES, INC
Entity type:Organization
Organization Name:GREAT WESTERN CHIROPRACTIC MANAGEMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:KEETCH
Authorized Official - Last Name:JEFFORDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-494-4940
Mailing Address - Street 1:382 E 720 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6342
Mailing Address - Country:US
Mailing Address - Phone:801-224-3661
Mailing Address - Fax:801-877-1718
Practice Address - Street 1:382 E 720 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6342
Practice Address - Country:US
Practice Address - Phone:801-224-3661
Practice Address - Fax:801-877-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty