Healthcare Provider Details

I. General information

NPI: 1982964201
Provider Name (Legal Business Name): JEFFREY ROBERT FAVERO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 E LOMOND VIEW DR # 102
NORTH OGDEN UT
84414-2269
US

IV. Provider business mailing address

365 E LOMOND VIEW DR # 102
NORTH OGDEN UT
84414-2269
US

V. Phone/Fax

Practice location:
  • Phone: 801-784-6306
  • Fax: 801-784-6316
Mailing address:
  • Phone: 801-784-6306
  • Fax: 801-784-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8317619-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: