Healthcare Provider Details

I. General information

NPI: 1528365566
Provider Name (Legal Business Name): COPPERWELL CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5069 W 13400 S SUITE 100
RIVERTON UT
84096-6601
US

IV. Provider business mailing address

5069 W 13400 S SUITE 100
RIVERTON UT
84096-6601
US

V. Phone/Fax

Practice location:
  • Phone: 801-253-8141
  • Fax: 801-253-2940
Mailing address:
  • Phone: 801-253-8141
  • Fax: 801-253-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7861490-1202
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TERAN WARNER
Title or Position: CO-OWNER
Credential: D.C.
Phone: 801-253-8141