Provider Demographics
NPI:1952557639
Name:UTAH SPINE AND DISC INC
Entity Type:Organization
Organization Name:UTAH SPINE AND DISC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEADORS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-262-3118
Mailing Address - Street 1:141 E 5600 S
Mailing Address - Street 2:STE 204
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6180
Mailing Address - Country:US
Mailing Address - Phone:801-262-3118
Mailing Address - Fax:801-262-3016
Practice Address - Street 1:141 E 5600 S
Practice Address - Street 2:STE 204
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6180
Practice Address - Country:US
Practice Address - Phone:801-262-3118
Practice Address - Fax:801-262-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTJ12387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty