Provider Demographics
NPI:1912158346
Name:AWERKAMP CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:AWERKAMP CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:AWERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-562-0135
Mailing Address - Street 1:8394 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0505
Mailing Address - Country:US
Mailing Address - Phone:801-562-0135
Mailing Address - Fax:801-562-0174
Practice Address - Street 1:8394 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0505
Practice Address - Country:US
Practice Address - Phone:801-562-0135
Practice Address - Fax:801-562-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT175587-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT558270121002Medicaid
000005871Medicare PIN
T48906Medicare UPIN