=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902328156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NECKS TO HEAVEN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 N 470 W
-----------------------------------------------------
City | AMERICAN FORK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84003-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-980-3388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 N 470 W
-----------------------------------------------------
City | AMERICAN FORK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84003-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-980-3388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. JEREME SCOTT SOMMERS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 801-980-3388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 10361444-1202
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------