Healthcare Provider Details

I. General information

NPI: 1023253739
Provider Name (Legal Business Name): PACIFIC DRIVE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 E PACIFIC DRIVE
AMERICAN FORK UT
84003-3033
US

IV. Provider business mailing address

999 E PACIFIC DRIVE
AMERICAN FORK UT
84003-3033
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-7800
  • Fax: 801-756-7805
Mailing address:
  • Phone: 801-756-7800
  • Fax: 801-756-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC C LEE
Title or Position: TREASURER
Credential: DC
Phone: 801-756-7800