Healthcare Provider Details

I. General information

NPI: 1104280452
Provider Name (Legal Business Name): R DANE OWENS CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 W MAIN ST STE A
SANTAQUIN UT
84655-5641
US

IV. Provider business mailing address

392 E 12300 S SUITE C
DRAPER UT
84020-8181
US

V. Phone/Fax

Practice location:
  • Phone: 801-609-7291
  • Fax:
Mailing address:
  • Phone: 801-849-1029
  • Fax: 801-890-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9710732-1202
License Number StateUT

VIII. Authorized Official

Name: ROBERT DANE OWENS
Title or Position: CHIROPRATIC PHYSICIAN
Credential: D.C.
Phone: 801-698-4493