Healthcare Provider Details

I. General information

NPI: 1053365239
Provider Name (Legal Business Name): RYAN E. EVERHART D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N STATE ST
MORGAN UT
84050-9919
US

IV. Provider business mailing address

PO BOX 135
MORGAN UT
84050-0135
US

V. Phone/Fax

Practice location:
  • Phone: 801-845-8156
  • Fax:
Mailing address:
  • Phone: 801-845-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX011203
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7443715-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: