Healthcare Provider Details

I. General information

NPI: 1013245521
Provider Name (Legal Business Name): BRYON L. ROSQUIST DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S 100 E STE 104
PLEASANT GROVE UT
84062-2751
US

IV. Provider business mailing address

405 S 100 E STE 104
PLEASANT GROVE UT
84062-2751
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-9411
  • Fax: 800-785-9417
Mailing address:
  • Phone: 801-785-9411
  • Fax: 800-785-9417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number168454-1202
License Number StateUT

VIII. Authorized Official

Name: DR. BRYON L ROSQUIST
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 801-785-9411