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General NPI Number Information
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NPI Number | 1801070628
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Entity Type | Organization
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Legal Business Name | MISUSTIN CHIROPRACTIC PC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 1415 N 400 E SUITE A
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City | LOGAN
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State | UT
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Zip | 84341-7539
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Country | US
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Telephone | 435-753-2840
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Fax | 435-787-9422
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Provider Business Mailing Address
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Address Line | 1415 N 400 E SUITE A
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City | LOGAN
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State | UT
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Zip | 84341-7539
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Country | US
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Telephone | 435-753-2840
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Fax | 435-787-9422
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES LAWRENCE MISUSTIN
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Credential | D.C.
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Telephone | 435-753-2840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 320260-1202
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License Number State | UT
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