Healthcare Provider Details

I. General information

NPI: 1619953254
Provider Name (Legal Business Name): STEPHEN MARK WHEELER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5974 FASHION POINT DR SUITE 110
SOUTH OGDEN UT
84403-4699
US

IV. Provider business mailing address

5974 FASHION POINT DR SUITE 110
SOUTH OGDEN UT
84403-4699
US

V. Phone/Fax

Practice location:
  • Phone: 801-621-1667
  • Fax: 801-475-6802
Mailing address:
  • Phone: 801-621-1667
  • Fax: 801-475-6802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2903031202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: