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General NPI Number Information
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NPI Number | 1255768438
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Entity Type | Organization
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Legal Business Name | VALLEY CHIROPRACTIC & WELLNESS LLC
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 663 N. MAIN ST.
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City | SPANISH FORK
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State | UT
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Zip | 84660-1144
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Country | US
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Telephone | 801-894-9633
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Fax | 801-386-5634
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Provider Business Mailing Address
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Address Line | 663 N. MAIN ST.
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City | SPANISH FORK
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State | UT
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Zip | 84660-1144
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Country | US
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Telephone | 801-894-9633
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Fax | 801-386-5634
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. ADAM RICHARD IDSINGA
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Credential | D.C.
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Telephone | 801-894-9633
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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 | 8530109-1202
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License Number State | UT
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