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General NPI Number Information
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NPI Number | 1689716177
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Entity Type | Organization
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Legal Business Name | BODYWORKS CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1218 WEST SOUTH JORDAN PARKWAY SUITE A
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City | SOUTH JORDAN
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State | UT
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Zip | 84095
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Country | US
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Telephone | 801-302-0301
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Fax | 801-302-0311
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Provider Business Mailing Address
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Address Line | 1218 WEST SOUTH JORDAN PARKWAY SUITE A
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City | SOUTH JORDAN
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State | UT
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Zip | 84095
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Country | US
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Telephone | 801-302-0301
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Fax | 801-302-0311
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MR. THERON B HALL
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Credential | DC
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Telephone | 801-302-0301
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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 | 3552091202
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License Number State | UT
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