MEDICARE: SIERRA TRINITY LADNIER 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	126299081202	UT

General Provider Information

NPI Number	:	1225789738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA TRINITY LADNIER DC

Provider Business Mailing Address
First Line	:	366 W SPRING CREEK PKWY
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9755
Country	:	US
Telephone Number	:	573-275-5736
Fax Number	:

Provider Business Practice Location Address
First Line	:	366 W SPRING CREEK PKWY
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9755
Country	:	US
Telephone Number	:	573-275-5736
Fax Number	:

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

Provider Enumeration Date	:	01/16/2022
Last Update Date	:	01/16/2022

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Directions to “ SIERRA TRINITY LADNIER DC” Practice Location

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