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General NPI Number Information
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NPI Number | 1558653899
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Entity Type | Organization
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Legal Business Name | DR CALVINS CLINIC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 2250 S REDWOOD RD STE 1
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-1348
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Country | US
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Telephone | 801-973-1022
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Fax | 801-973-0090
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Provider Business Mailing Address
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Address Line | 2250 S REDWOOD RD STE 1
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-1348
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Country | US
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Telephone | 801-973-1022
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Fax | 801-973-0090
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Authorized Official
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Title or Position | OWNER
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Name | CALVIN M BEAUGEZ
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Credential | D.C.
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Telephone | 801-973-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 334984-1202
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License Number State | UT
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