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General NPI Number Information
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NPI Number | 1649791062
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Entity Type | Organization
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Legal Business Name | NORTHERN ROCKIES HOLDINGS
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6216 S REDWOOD RD
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City | SLC
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State | UT
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Zip | 84123-6630
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Country | US
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Telephone | 801-974-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 6216 S REDWOOD RD
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City | SLC
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State | UT
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Zip | 84123-6630
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Country | US
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Telephone | 801-974-5555
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. GARY LEE
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Credential | D.C.
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Telephone | 801-897-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 10390897-1714
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License Number State | UT
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