Healthcare Provider Details

I. General information

NPI: 1538344783
Provider Name (Legal Business Name): APPLEGATE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 E 5900 S B107
MURRAY UT
84107-7257
US

IV. Provider business mailing address

166 E 5900 S B107
MURRAY UT
84107-7257
US

V. Phone/Fax

Practice location:
  • Phone: 801-313-0111
  • Fax: 801-313-0116
Mailing address:
  • Phone: 801-313-0111
  • Fax: 801-313-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1743231202
License Number StateUT

VIII. Authorized Official

Name: DR. KIRK ALLEN APPLEGATE
Title or Position: OWNER
Credential: D.C.
Phone: 801-313-0111