Healthcare Provider Details

I. General information

NPI: 1437994845
Provider Name (Legal Business Name): RICHARD MATTHEW WINN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 W SMELTER ST
MIDVALE UT
84047-7111
US

IV. Provider business mailing address

3224 W NEW WORLD DR
WEST JORDAN UT
84084-2703
US

V. Phone/Fax

Practice location:
  • Phone: 801-810-7070
  • Fax: 810-810-1104
Mailing address:
  • Phone: 801-810-7070
  • Fax: 801-810-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13754571-1202
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number13754571-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: