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General NPI Number Information
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NPI Number | 1477048858
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Entity Type | Organization
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Legal Business Name | HOMETOWN HEALTHCARE LLC
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 591 N STATE ROAD 198
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City | SALEM
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State | UT
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Zip | 84653-5668
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Country | US
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Telephone | 801-504-6370
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Fax | 801-504-6095
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Provider Business Mailing Address
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Address Line | 591 N STATE ROAD 198
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City | SALEM
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State | UT
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Zip | 84653-5668
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Country | US
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Telephone | 801-504-6370
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Fax | 801-504-6095
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. TERRILL LANE PHELPS JR.
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Credential | DC
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Telephone | 801-504-6370
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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 | 10250498-1202
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License Number State | UT
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