Healthcare Provider Details

I. General information

NPI: 1013900067
Provider Name (Legal Business Name): ROBERT LAWRENCE MECHLING D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

2332 W 12600 S SUITE D
RIVERTON UT
84065-7161
US

IV. Provider business mailing address

2332 W 12600 S SUITE D
RIVERTON UT
84065-7161
US

V. Phone/Fax

Practice location:
  • Phone: 801-302-9400
  • Fax: 801-302-9401
Mailing address:
  • Phone: 801-302-9400
  • Fax: 801-302-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number338800-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: