MEDICARE: DR. BLAKE FENTON D.C.

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	6796488-1202	UT

General Provider Information

NPI Number	:	1245417773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE FENTON D.C.

Provider Business Mailing Address
First Line	:	146 E 4600 S
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-5946
Country	:	US
Telephone Number	:	801-627-2023
Fax Number	:	801-627-2048

Provider Business Practice Location Address
First Line	:	146 E 4600 S
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-5946
Country	:	US
Telephone Number	:	801-627-2023
Fax Number	:	801-627-2048

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

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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Directions to “ DR. BLAKE FENTON D.C.” Practice Location

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