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General NPI Number Information
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NPI Number | 1134375751
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Entity Type | Organization
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Legal Business Name | ROSQUIST GROUP P C
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 3409 W 12600 S #200
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City | RIVERTON
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State | UT
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Zip | 84065
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Country | US
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Telephone | 801-676-8770
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Fax | 801-676-8772
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Provider Business Mailing Address
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Address Line | 3409 W 12600 S #200
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City | RIVERTON
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State | UT
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Zip | 84065
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Country | US
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Telephone | 801-676-8770
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Fax | 801-676-8772
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY ROSQUIST
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Credential |
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Telephone | 801-676-8770
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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 | 174224-1202
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License Number State | UT
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