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General NPI Number Information
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NPI Number | 1902212806
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Entity Type | Organization
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Legal Business Name | INJURY RECOVERY SPECIALISTS
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 1437 W MIDAS CREEK DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-7879
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Country | US
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Telephone | 801-376-9596
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Fax | 801-907-7574
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Provider Business Mailing Address
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Address Line | 1437 W MIDAS CREEK DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-7879
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Country | US
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Telephone | 801-376-9596
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Fax | 801-907-7574
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TOM GRANT JR.
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Credential | DC
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Telephone | 801-376-9596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 6715760-1202
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License Number State | UT
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