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NPI Code Detail

MEDICARE: MAPLE MOUNTAIN SPINAL REHAB, PLLC

MEDICARE: MAPLE MOUNTAIN SPINAL REHAB, PLLC
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
1111N00000XChiropractor3136171202UT

General Provider Information

NPI Number : 1225435316
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAPLE MOUNTAIN SPINAL REHAB, PLLC
Provider Business Mailing Address
First Line : 1247 EXPRESSWAY LN
Second Line :
City : SPANISH FORK
State : UT
Zip : 84660-1333
Country : US
Telephone Number : 801-691-1581
Fax Number :
Provider Business Practice Location Address
First Line : 1247 EXPRESSWAY LN
Second Line :
City : SPANISH FORK
State : UT
Zip : 84660-1333
Country : US
Telephone Number : 801-691-1581
Fax Number :
Authorized Official
Title or Position : DOCTOR
Name : SHANNON D MCKINNEY
Credential : DC
Telephone Number : 801-691-1581
Provider Enumeration Date : 12/04/2014
Last Update Date : 12/04/2014

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