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General NPI Number Information
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NPI Number | 1053854596
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Entity Type | Organization
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Legal Business Name | CARBON CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 12/01/2016
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 39 N 600 E
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City | PRICE
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State | UT
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Zip | 84501-2624
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Country | US
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Telephone | 435-637-0450
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Fax |
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Provider Business Mailing Address
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Address Line | 39 N 600 E
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City | PRICE
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State | UT
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Zip | 84501-2624
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Country | US
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Telephone | 435-637-0450
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN WILLIAM THAYN
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Credential | D.C., B.S., M.S.
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Telephone | 435-637-0450
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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 | 8399884-1202
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License Number State | UT
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