Healthcare Provider Details

I. General information

NPI: 1356252704
Provider Name (Legal Business Name): TORIN CHADBURN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 KIESEL AVE
OGDEN UT
84401-1964
US

IV. Provider business mailing address

1181 W FALLOW WAY
PLEASANT VIEW UT
84414-1929
US

V. Phone/Fax

Practice location:
  • Phone: 801-528-5066
  • Fax: 801-528-5067
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14305202-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: