MEDICARE: DR. MICHAEL RON FROGLEY 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	6790232-1202	UT

General Provider Information

NPI Number	:	1316126741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RON FROGLEY D.C.

Provider Business Mailing Address
First Line	:	1264 VILLAGE MAIN DR UNIT A
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-1952
Country	:	US
Telephone Number	:	801-972-5285
Fax Number	:

Provider Business Practice Location Address
First Line	:	1264 VILLAGE MAIN DR UNIT A
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-1952
Country	:	US
Telephone Number	:	801-972-5285
Fax Number	:

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	11/01/2007

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