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General NPI Number Information
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NPI Number | 1013216944
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Entity Type | Organization
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Legal Business Name | INSPIRED LIFE SANCTUARY LLC
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Dates
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Enumeration Date | 03/17/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 8541 REDWOOD RD # D
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City | WEST JORDAN
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State | UT
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Zip | 84088-9327
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Country | US
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Telephone | 801-233-9050
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Fax | 801-233-9051
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Provider Business Mailing Address
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Address Line | 8541 REDWOOD RD # D
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City | WEST JORDAN
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State | UT
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Zip | 84088-9327
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Country | US
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Telephone | 801-233-9050
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Fax | 801-233-9051
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Authorized Official
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Title or Position | OWNER
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Name | MS. RUDI CHAMU
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Credential | D.C.
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Telephone | 801-233-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7570323-1202
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License Number State | UT
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