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General NPI Number Information
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NPI Number | 1902864457
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Entity Type | Individual
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Provider Name | JARED ANDERSON BONNETTE D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 40 W MAIN STREET CT SUITE 175
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City | ALPINE
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State | UT
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Zip | 84004-5600
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Country | US
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Telephone | 801-770-3275
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Fax | 810-770-3300
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Provider Business Mailing Address
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Address Line | 40 W MAIN STREET CT SUITE 175
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City | ALPINE
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State | UT
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Zip | 84004-5600
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Country | US
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Telephone | 801-770-3275
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Fax | 810-770-3300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6970420-1202
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5486
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License Number State | CO
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