Healthcare Provider Details

I. General information

NPI: 1376680603
Provider Name (Legal Business Name): CHIROPRACTIC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3646 S. REDWOOD RD, SUITE W-1
WEST VALLEY CITY UT
84119
US

IV. Provider business mailing address

3646 S. REDWOOD RD, SUITE W-1
WEST VALLEY CITY UT
84119
US

V. Phone/Fax

Practice location:
  • Phone: 801-974-5644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number176317-1202
License Number StateUT

VIII. Authorized Official

Name: DR. WILSON RICHARD BARTON
Title or Position: OVERSEER
Credential: DC, MD
Phone: 801-974-5644