Healthcare Provider Details

I. General information

NPI: 1770352908
Provider Name (Legal Business Name): WESTON MARK SORENSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 N UNIVERSITY AVE STE 175
PROVO UT
84604-6620
US

IV. Provider business mailing address

3355 N UNIVERSITY AVE STE 175
PROVO UT
84604-6620
US

V. Phone/Fax

Practice location:
  • Phone: 801-623-0912
  • Fax:
Mailing address:
  • Phone: 801-658-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7644002-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: