Healthcare Provider Details

I. General information

NPI: 1215702634
Provider Name (Legal Business Name): ASPIRE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S MAIN ST STE 3
PLEASANT GROVE UT
84062-2650
US

IV. Provider business mailing address

140 S MAIN ST STE 3
PLEASANT GROVE UT
84062-2650
US

V. Phone/Fax

Practice location:
  • Phone: 801-899-3904
  • Fax:
Mailing address:
  • Phone: 801-899-3904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: TYFFANI C JACKSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 801-899-3904