Provider Demographics
NPI:1932630837
Name:EARLE, IAN SEQUOIA (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:SEQUOIA
Last Name:EARLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 DERRICK CIR
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9402
Mailing Address - Country:US
Mailing Address - Phone:425-249-6497
Mailing Address - Fax:
Practice Address - Street 1:5640 S WASATCH DR
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1908
Practice Address - Country:US
Practice Address - Phone:801-388-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60721616111N00000X
UT10224169-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor