Healthcare Provider Details

I. General information

NPI: 1831904523
Provider Name (Legal Business Name): THE BRAIN AND BODY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MAIN ST STE 101
HEBER CITY UT
84032-1670
US

IV. Provider business mailing address

150 N MAIN ST STE 101
HEBER CITY UT
84032-1670
US

V. Phone/Fax

Practice location:
  • Phone: 801-584-9175
  • Fax:
Mailing address:
  • Phone: 801-584-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIE YEH SHELTON
Title or Position: OWNER
Credential: DO
Phone: 801-584-9175