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General NPI Number Information
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NPI Number | 1427262195
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Entity Type | Organization
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Legal Business Name | CANYON RIDGE CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 520 MEDICAL DR STE 200
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8928
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Country | US
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Telephone | 801-292-4400
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Fax | 844-308-6615
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Provider Business Mailing Address
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Address Line | 520 MEDICAL DR STE 200
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8928
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Country | US
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Telephone | 801-292-4400
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Fax | 844-308-6615
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC MEDICINE
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Name | DR. JASON LARRY SMITH
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Credential | DC, MS, DACNB
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Telephone | 801-292-4400
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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 | 369867-1202
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License Number State | UT
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