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General NPI Number Information
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NPI Number | 1447400114
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Entity Type | Organization
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Legal Business Name | HIGH FIVE CHIROPRACTIC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 456 STATE ROAD 198
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City | SALEM
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State | UT
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Zip | 84653-9187
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Country | US
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Telephone | 801-423-3555
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Fax | 801-423-2855
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Provider Business Mailing Address
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Address Line | 456 NORTH S.R. 198
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City | SALEM
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State | UT
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Zip | 84653
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Country | US
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Telephone | 801-423-3555
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Fax | 801-423-2855
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADLEY MARK SHEPHERD
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Credential | D.C.
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Telephone | 801-636-7499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 71183171202
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License Number State | UT
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