Healthcare Provider Details

I. General information

NPI: 1952262313
Provider Name (Legal Business Name): PROVO PEAK CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 N UNIVERSITY AVE STE 105
PROVO UT
84601-8422
US

IV. Provider business mailing address

363 N UNIVERSITY AVE STE 105
PROVO UT
84601-8422
US

V. Phone/Fax

Practice location:
  • Phone: 801-874-3455
  • Fax:
Mailing address:
  • Phone: 801-874-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JASON THOMSEN
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 863-326-8811