Provider Demographics
NPI:1831186634
Name:RESETARITS, MARK BRADLEY (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRADLEY
Last Name:RESETARITS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2171
Mailing Address - Country:US
Mailing Address - Phone:801-363-8899
Mailing Address - Fax:801-363-1221
Practice Address - Street 1:223 S 700 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2171
Practice Address - Country:US
Practice Address - Phone:801-363-8899
Practice Address - Fax:801-363-1221
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT931763121202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU39228Medicare UPIN