Provider Demographics
NPI:1831594456
Name:EXCEL CHIROPRACTIC AND SPORTS MEDICINE
Entity type:Organization
Organization Name:EXCEL CHIROPRACTIC AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-362-3167
Mailing Address - Street 1:168 E 1130 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3256
Mailing Address - Country:US
Mailing Address - Phone:801-362-3167
Mailing Address - Fax:
Practice Address - Street 1:720 E NEW ENGLAND DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3590
Practice Address - Country:US
Practice Address - Phone:801-523-2582
Practice Address - Fax:801-523-2582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9178910-1202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center