Healthcare Provider Details

I. General information

NPI: 1285728899
Provider Name (Legal Business Name): BRYCE HOUGAARD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRYCE HOUGAARD DC

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-8882
US

IV. Provider business mailing address

PO BOX 5
MILLVILLE UT
84326-0005
US

V. Phone/Fax

Practice location:
  • Phone: 801-523-8700
  • Fax: 801-523-8191
Mailing address:
  • Phone: 435-232-4279
  • Fax: 888-668-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number176437-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: