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General NPI Number Information
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NPI Number | 1548430820
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH CHIROPRACTIC
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 3075 WEST 7800 SOUTH
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City | WEST JORDAN
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State | UT
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Zip | 84088-2802
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Country | US
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Telephone | 801-565-9500
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Fax | 801-304-7046
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Provider Business Mailing Address
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Address Line | 3075 W 7800 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-2802
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Country | US
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Telephone | 801-565-9500
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Fax | 801-304-7046
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC J BERUBE
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Credential | DC
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Telephone | 801-565-9500
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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 | 292911-1202
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License Number State | UT
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