Healthcare Provider Details
I. General information
NPI: 1205777398
Provider Name (Legal Business Name): GENTLE ROOTS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2909 WASHINGTON BLVD STE 221
OGDEN UT
84401-4055
US
IV. Provider business mailing address
850 E 1400 S APT C102
CLEARFIELD UT
84015-2656
US
V. Phone/Fax
- Phone: 707-575-0750
- Fax:
- Phone: 707-575-0750
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ELENA
DEVANEY
MORRIS
Title or Position: OWNER
Credential: D.C.
Phone: 707-575-0750