Healthcare Provider Details

I. General information

NPI: 1649360140
Provider Name (Legal Business Name): L SCOTT JEWKES D.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4578 HIGHLAND DR STE. 100
SALT LAKE CITY UT
84117-4243
US

IV. Provider business mailing address

1462 TUMBLEWEED WAY
DRAPER UT
84020-7682
US

V. Phone/Fax

Practice location:
  • Phone: 801-272-4260
  • Fax: 801-272-2827
Mailing address:
  • Phone: 801-560-1748
  • Fax: 801-272-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number100470-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: