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General NPI Number Information
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NPI Number | 1477746485
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Entity Type | Organization
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Legal Business Name | DYNAMIC HEALTH CARE OF UTAH LLC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 559 W STATE RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2111
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Country | US
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Telephone | 801-756-3888
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Fax | 801-471-2777
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Provider Business Mailing Address
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Address Line | 559 W STATE RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2111
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Country | US
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Telephone | 801-756-3888
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Fax | 801-471-2777
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE R LOWRY
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Credential | D.C.
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Telephone | 801-756-3888
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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 | 5017692-1202
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License Number State | UT
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