Healthcare Provider Details

I. General information

NPI: 1770526394
Provider Name (Legal Business Name): DONALD RAMON CANOVA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MAIN 5B
CLEARFIELD UT
84015
US

IV. Provider business mailing address

2922 W 1800 N
CLINTON UT
84015-7610
US

V. Phone/Fax

Practice location:
  • Phone: 801-776-3389
  • Fax: 801-775-9393
Mailing address:
  • Phone: 801-776-3389
  • Fax: 801-775-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number269016-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: