Healthcare Provider Details

I. General information

NPI: 1366778201
Provider Name (Legal Business Name): ADVANCED SPINAL REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 03/29/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 UNIVERSITY PARK BLVD
CLEARFIELD UT
84015-6283
US

IV. Provider business mailing address

938 UNIVERSITY PARK BLVD
CLEARFIELD UT
84015-6283
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-4130
  • Fax:
Mailing address:
  • Phone: 801-773-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. COREY D BOWDEN
Title or Position: OWNER/PHYSICIAN
Credential: DC
Phone: 801-444-1230