=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023328432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEREMY P. WIMMER CHIROPRACTIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2010
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6095 S FASHION BLVD STE 130
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84107-7383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-506-7890
-----------------------------------------------------
Fax | 801-506-7891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6095 S FASHION BLVD STE 130
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84107-7383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-506-7890
-----------------------------------------------------
Fax | 801-506-7891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEREMY P WIMMER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 801-506-7890
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 343365-1202
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------