Healthcare Provider Details

I. General information

NPI: 1518081819
Provider Name (Legal Business Name): INJURY & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 E 4500 S
MURRAY UT
84107-3883
US

IV. Provider business mailing address

291 E 4500 S
MURRAY UT
84107-3883
US

V. Phone/Fax

Practice location:
  • Phone: 801-264-1010
  • Fax: 801-264-1027
Mailing address:
  • Phone: 801-264-1010
  • Fax: 801-264-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2125511202
License Number StateUT

VIII. Authorized Official

Name: DR. CRAIG ALLEN BLAMIRES
Title or Position: ADMIN
Credential: DC,FNP
Phone: 801-264-1010