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General NPI Number Information
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NPI Number | 1033396775
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Entity Type | Organization
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Legal Business Name | CENTER FOR TEAM HEALTHCARE
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 1901 PROSPECTOR AVE STE 10
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City | PARK CITY
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State | UT
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Zip | 84060-7207
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Country | US
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Telephone | 435-649-1542
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Fax | 435-658-4909
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Provider Business Mailing Address
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Address Line | 1901 PROSPECTOR AVE STE 10
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City | PARK CITY
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State | UT
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Zip | 84060-7550
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Country | US
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Telephone | 435-649-1542
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Fax | 435-658-4909
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHAN J BLACK
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Credential | D.C.
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Telephone | 435-649-1542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 221669991202
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License Number State | UT
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