Healthcare Provider Details

I. General information

NPI: 1659187540
Provider Name (Legal Business Name): KET CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
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: 888-431-2763
Mailing address:
  • Phone: 801-785-9411
  • Fax: 888-431-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KEREN RICE
Title or Position: PRESIDENT
Credential: DC
Phone: 918-812-9866