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General NPI Number Information
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NPI Number | 1639350341
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Entity Type | Organization
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Legal Business Name | COLARUSSO FAMILY CHIROPRACTIC, PC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 12571 S. PASTURE ROAD SUITE E
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City | RIVERTON
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State | UT
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Zip | 84096-7037
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Country | US
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Telephone | 801-878-3645
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Fax | 801-878-3647
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Provider Business Mailing Address
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Address Line | 12571 S. PASTURE ROAD SUITE E
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City | RIVERTON
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State | UT
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Zip | 84096-7037
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Country | US
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Telephone | 801-878-3645
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Fax | 801-878-3647
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN JOSEPH COLARUSSO
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Credential | D.C.
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Telephone | 801-878-3645
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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 | 5072634-1202
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License Number State | UT
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