Healthcare Provider Details

I. General information

NPI: 1376887927
Provider Name (Legal Business Name): ERIC C CHENWORTH D.O.P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13348 S MARKET CENTER DR STE 220
RIVERTON UT
84065-8011
US

IV. Provider business mailing address

13348 S MARKET CENTER DR STE 220
RIVERTON UT
84065-8011
US

V. Phone/Fax

Practice location:
  • Phone: 385-290-1289
  • Fax: 385-290-1290
Mailing address:
  • Phone: 385-290-1289
  • Fax: 385-290-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC CHENWORTH
Title or Position: PRESIDENT
Credential: D.O
Phone: 385-290-1289