MEDICARE: RYAN ALLEN ATKINSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5188221-1202	UT

General Provider Information

NPI Number	:	1053388314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN ALLEN ATKINSON DC

Provider Business Mailing Address
First Line	:	2179 W 1800 N
Second Line	:
City	:	CLINTON
State	:	UT
Zip	:	84015-7900
Country	:	US
Telephone Number	:	801-614-0166
Fax Number	:	801-614-0167

Provider Business Practice Location Address
First Line	:	2179 W 1800 N
Second Line	:
City	:	CLINTON
State	:	UT
Zip	:	84015-7900
Country	:	US
Telephone Number	:	801-614-0166
Fax Number	:	801-614-0167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	12/12/2008

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Directions to “ RYAN ALLEN ATKINSON DC” Practice Location

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