Healthcare Provider Details

I. General information

NPI: 1306470430
Provider Name (Legal Business Name): LIFE SOURCE CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8777 S REDWOOD RD STE 250
WEST JORDAN UT
84088-9101
US

IV. Provider business mailing address

8777 S REDWOOD RD STE 250
WEST JORDAN UT
84088-9101
US

V. Phone/Fax

Practice location:
  • Phone: 801-251-6498
  • Fax:
Mailing address:
  • Phone: 801-251-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA TYLER ADAMS
Title or Position: OWNER/OPERATOR
Credential: D.C.
Phone: 801-251-6498