Healthcare Provider Details

I. General information

NPI: 1295936565
Provider Name (Legal Business Name): ANDERSON CHIROPRACTIC CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 KIRBY LN STE 103
SPANISH FORK UT
84660-5753
US

IV. Provider business mailing address

642 KIRBY LN STE 103
SPANISH FORK UT
84660-5753
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-6558
  • Fax: 801-798-3690
Mailing address:
  • Phone: 801-798-6558
  • Fax: 801-798-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number270891-1202
License Number StateUT

VIII. Authorized Official

Name: DR. JAY D. ANDERSON
Title or Position: OWNER
Credential: DC
Phone: 801-798-6558