Healthcare Provider Details

I. General information

NPI: 1760669998
Provider Name (Legal Business Name): DUDLEY CHIROPRACTIC & WELLNESS CENTER LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 E 2100 S
SALT LAKE CITY UT
84106
US

IV. Provider business mailing address

1053 E 2100 S
SALT LAKE CITY UT
84106-2349
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-3995
  • Fax: 801-359-8489
Mailing address:
  • Phone: 801-359-3995
  • Fax: 801-359-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DUDLEY
Title or Position: OWNER
Credential: DC
Phone: 801-359-3995