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General NPI Number Information
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NPI Number | 1073805289
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Entity Type | Organization
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Legal Business Name | SPINE AND MUSCULAR REHABILITATION CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 1634 N MAIN ST
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City | NORTH LOGAN
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State | UT
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Zip | 84341-1920
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Country | US
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Telephone | 208-351-8329
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Fax |
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Provider Business Mailing Address
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Address Line | 60 N CENTER ST PO BOX 335
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City | WELLSVILLE
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State | UT
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Zip | 84339-9412
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Country | US
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Telephone |
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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. TRENTON STEVENS
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Credential | D.C.
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Telephone | 208-351-8329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 7975292-1202
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License Number State | UT
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