Healthcare Provider Details

I. General information

NPI: 1558360362
Provider Name (Legal Business Name): JAY DOYLE ANDERSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date: 03/17/2006
Reactivation Date: 04/04/2006

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 Number942708911202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: