Healthcare Provider Details

I. General information

NPI: 1649462136
Provider Name (Legal Business Name): KIRK ALLEN APPLEGATE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 E 5900 S SUITE B107
MURRAY UT
84107-7257
US

IV. Provider business mailing address

166 E 5900 S SUITE 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 Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1743231202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: