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General NPI Number Information
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NPI Number | 1184118028
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Entity Type | Organization
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Legal Business Name | BEN LOMOND CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 428 E 2600 N STE #5
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City | NORTH OGDEN
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State | UT
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Zip | 84414
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Country | US
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Telephone | 801-782-0987
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Fax | 801-782-7518
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Provider Business Mailing Address
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Address Line | 428 E 2600 N STE #5
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City | NORTH OGDEN
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State | UT
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Zip | 84414
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Country | US
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Telephone | 801-782-0987
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Fax | 801-782-7518
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JOHN G TANNER
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Credential | D.C.
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Telephone | 801-782-0987
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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 | 6929478-1202
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5960456-1202
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License Number State | UT
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