Healthcare Provider Details

I. General information

NPI: 1588489686
Provider Name (Legal Business Name): DJC SPINE INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 S FASHION BLVD STE 200
MURRAY UT
84107-7210
US

IV. Provider business mailing address

5911 S FASHION BLVD STE 200
MURRAY UT
84107-7210
US

V. Phone/Fax

Practice location:
  • Phone: 385-541-2230
  • Fax: 385-541-2200
Mailing address:
  • Phone: 385-541-2230
  • Fax: 385-541-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JULI CALL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 385-541-2230