Provider Demographics
NPI:1831626993
Name:SUMMIT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORBIE
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-862-0125
Mailing Address - Street 1:1397 W SUNSET BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4212
Mailing Address - Country:US
Mailing Address - Phone:435-862-0125
Mailing Address - Fax:435-215-7680
Practice Address - Street 1:1397 W SUNSET BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4212
Practice Address - Country:US
Practice Address - Phone:435-862-0125
Practice Address - Fax:435-215-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8328842-1202111N00000X
UT5322635-4405363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty