Provider Demographics
NPI:1841489424
Name:BIO ENERGY SYNERGY TECHNOLOGY CHIROPRACTIC L.L.C.
Entity type:Organization
Organization Name:BIO ENERGY SYNERGY TECHNOLOGY CHIROPRACTIC L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOFTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-298-9190
Mailing Address - Street 1:1355 N MAIN ST
Mailing Address - Street 2:STE 6
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5982
Mailing Address - Country:US
Mailing Address - Phone:801-298-9190
Mailing Address - Fax:801-298-2451
Practice Address - Street 1:1355 N MAIN ST
Practice Address - Street 2:STE 6
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5982
Practice Address - Country:US
Practice Address - Phone:801-298-9190
Practice Address - Fax:801-298-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4821942-1202111N00000X
UT170238-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057006Medicare PIN
UT000057006Medicare UPIN