Provider Demographics
NPI: | 1932349842 |
---|---|
Name: | JW DUGGAR, INC |
Entity Type: | Organization |
Organization Name: | JW DUGGAR, INC |
Other - Org Name: | I AM WELLNESS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JERALD |
Authorized Official - Middle Name: | W |
Authorized Official - Last Name: | DUGGAR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 801-677-7878 |
Mailing Address - Street 1: | 485 S 100 E |
Mailing Address - Street 2: | |
Mailing Address - City: | BOUNTIFUL |
Mailing Address - State: | UT |
Mailing Address - Zip Code: | 84010-4903 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 801-677-7878 |
Mailing Address - Fax: | 866-280-1559 |
Practice Address - Street 1: | 485 S 100 E |
Practice Address - Street 2: | |
Practice Address - City: | BOUNTIFUL |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84010-4903 |
Practice Address - Country: | US |
Practice Address - Phone: | 801-677-7878 |
Practice Address - Fax: | 866-280-1559 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-03-05 |
Last Update Date: | 2012-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
UT | 3684641202 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |