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General NPI Number Information
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NPI Number | 1760789374
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Entity Type | Organization
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Legal Business Name | RIVERTON CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 3409 W 12600 S SUITE 200
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City | RIVERTON
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State | UT
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Zip | 84065-7260
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Country | US
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Telephone | 801-750-0901
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Fax |
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Provider Business Mailing Address
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Address Line | 3409 W 12600 S SUITE 200
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City | RIVERTON
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State | UT
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Zip | 84065-7260
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Country | US
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Telephone | 801-750-0901
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MICHAEL JOHN SMITH JR.
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Credential | D.C.
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Telephone | 801-688-3693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 7845949-1202
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License Number State | UT
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