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General NPI Number Information
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NPI Number | 1255749677
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Entity Type | Organization
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Legal Business Name | IRON MOUNTAIN CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 13268 S 5600 W
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City | HERRIMAN
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State | UT
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Zip | 84096-7776
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Country | US
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Telephone | 303-319-1926
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Fax |
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Provider Business Mailing Address
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Address Line | 13268 S 5600 W
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City | HERRIMAN
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State | UT
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Zip | 84096-7776
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Country | US
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Telephone | 303-319-1926
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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. CLAYTON HORSTMAN
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Credential | D.C.
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Telephone | 303-319-1926
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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 | 2014014536
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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