Healthcare Provider Details

I. General information

NPI: 1720402324
Provider Name (Legal Business Name): NMG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 S 4490 W ST. C & D
SALT LAKE CITY UT
84104-4740
US

IV. Provider business mailing address

PO BOX 26543
SALT LAKE CITY UT
84126-0543
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-3228
  • Fax:
Mailing address:
  • Phone: 801-747-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: RHONDA NOBLE
Title or Position: OWNER
Credential:
Phone: 801-747-3228