MEDICARE: DEXA BODY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QR0208X	Mobile Radiology Clinic/Center
2	261QR1100X	Research Clinic/Center
3	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
4	261QG0250X	Genetics Clinic/Center
5	261QH0100X	Health Service Clinic/Center
6	261QR0200X	Radiology Clinic/Center
7	261Q00000X	Clinic/Center
8	261QC1800X	Corporate Health Clinic/Center
9	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1508488008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEXA BODY INC

Provider Business Mailing Address
First Line	:	5263 S COMMERCE DR STE 201
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-5306
Country	:	US
Telephone Number	:	801-274-3392
Fax Number	:	801-274-3392

Provider Business Practice Location Address
First Line	:	5263 S COMMERCE DR STE 201
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-5306
Country	:	US
Telephone Number	:	801-274-3392
Fax Number	:	801-274-3392

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. BRANDON SHEPPARD
Credential	:
Telephone Number	:	801-428-8350

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	06/18/2024

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Directions to “DEXA BODY INC ” Practice Location

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