Healthcare Provider Details

I. General information

NPI: 1336579655
Provider Name (Legal Business Name): FOUNDATION CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 N STATE ST
OREM UT
84057-3806
US

IV. Provider business mailing address

608 N STATE ST
OREM UT
84057-3806
US

V. Phone/Fax

Practice location:
  • Phone: 801-358-8198
  • Fax:
Mailing address:
  • Phone: 801-358-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number8139801-1202
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JEFFRY C BROWN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 801-358-8198