Healthcare Provider Details

I. General information

NPI: 1033168372
Provider Name (Legal Business Name): CORY M FROGLEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 N 500 W
BOUNTIFUL UT
84010-6948
US

IV. Provider business mailing address

458 N 500 W
BOUNTIFUL UT
84010-6948
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-9355
  • Fax: 801-296-8050
Mailing address:
  • Phone: 801-292-9355
  • Fax: 801-296-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4828483-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: