MEDICARE: ADJUSTMENT33

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	7733054-1202	UT

General Provider Information

NPI Number	:	1922530955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADJUSTMENT33

Provider Business Mailing Address
First Line	:	5204 S REDWOOD RD
Second Line	:	STE C3
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84123-4217
Country	:	US
Telephone Number	:	801-987-0335
Fax Number	:

Provider Business Practice Location Address
First Line	:	5204 S REDWOOD RD
Second Line	:	STE C3
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84123-4217
Country	:	US
Telephone Number	:	801-987-0335
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND OPERATOR
Name	:	DR. SPENCER CHASE GARDNER
Credential	:	ATC, DC
Telephone Number	:	801-580-3345

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	04/27/2017

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