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General NPI Number Information
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NPI Number | 1366632200
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Entity Type | Organization
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Legal Business Name | CASCADE CHIROPRACTIC AND ACCIDENT REHABILITATION LLC
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 3123 W 5400 S
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City | TAYLORSVILLE
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State | UT
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Zip | 84118-2271
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Country | US
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Telephone | 180-196-7082
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Fax |
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Provider Business Mailing Address
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Address Line | 3123 W 5400 S
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City | TAYLORSVILLE
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State | UT
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Zip | 84118-2271
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Country | US
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Telephone | 180-196-7082
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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. BRETT WAYNE PROCTOR
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Credential | D.C.
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Telephone | 18019670825
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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 | 6562898-1202
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License Number State | UT
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