Healthcare Provider Details

I. General information

NPI: 1699830786
Provider Name (Legal Business Name): DIRK S. WOODMANSEE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 S 900 E STE 100
MURRAY UT
84117-7286
US

IV. Provider business mailing address

5320 S 900 E STE 100
MURRAY UT
84117-7286
US

V. Phone/Fax

Practice location:
  • Phone: 385-743-9213
  • Fax: 385-394-0330
Mailing address:
  • Phone: 385-743-9213
  • Fax: 385-394-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number97-350712-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: