Healthcare Provider Details

I. General information

NPI: 1215241096
Provider Name (Legal Business Name): SNOW CANYON CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2297 SANTA CLARA DR
SANTA CLARA UT
84765-5459
US

IV. Provider business mailing address

2297 SANTA CLARA DR
SANTA CLARA UT
84765-5459
US

V. Phone/Fax

Practice location:
  • Phone: 435-229-8044
  • Fax:
Mailing address:
  • Phone: 435-229-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6575475-1202
License Number StateUT

VIII. Authorized Official

Name: DR. JEREMY DAVID SWINDLEHURST
Title or Position: MANAGER/OWNER
Credential: D.C.
Phone: 435-229-8044