Healthcare Provider Details

I. General information

NPI: 1083880025
Provider Name (Legal Business Name): ASPEN CHIROPRACTIC CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 E 800 S #101
OREM UT
84097-6309
US

IV. Provider business mailing address

381 E 800 S #101
OREM UT
84097-6309
US

V. Phone/Fax

Practice location:
  • Phone: 801-234-6325
  • Fax: 801-221-1655
Mailing address:
  • Phone: 801-234-6325
  • Fax: 801-221-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number358787-1202
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3948
License Number StateIA

VIII. Authorized Official

Name: PAUL GURNEY
Title or Position: OWNER
Credential: D.C.
Phone: 801-234-6325