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General NPI Number Information
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NPI Number | 1699943910
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Entity Type | Organization
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Legal Business Name | MAPLE RIDGE CHIROPRACTIC
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 10965 SOUTH RIVER FRONT PKWY
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-3538
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Country | US
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Telephone | 801-878-3304
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Fax | 888-466-7751
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Provider Business Mailing Address
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Address Line | 10965 SOUTH RIVER FRONT PKWY
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-3538
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Country | US
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Telephone | 801-878-3304
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Fax | 888-466-7751
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Authorized Official
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Title or Position | OWNER
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Name | JOEL TEMPLETON
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Credential | DC
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Telephone | 801-878-3304
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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 | 51874351202
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License Number State | UT
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