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General NPI Number Information
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NPI Number | 1063561009
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Entity Type | Individual
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Provider Name | TRENT J. BURRUP D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1847 W 9000 S STE 105
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City | WEST JORDAN
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State | UT
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Zip | 84088-8605
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Country | US
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Telephone | 801-567-0557
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Fax | 801-567-0546
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Provider Business Mailing Address
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Address Line | 14043 FRIENDSHIP DR
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City | HERRIMAN
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State | UT
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Zip | 84065-1787
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Country | US
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Telephone | 801-446-6981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 267200-1202
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License Number State | UT
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