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General NPI Number Information
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NPI Number | 1962801407
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Entity Type | Organization
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Legal Business Name | DANA CHIROPRACTIC
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 1219 N 400 E
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City | LOGAN
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State | UT
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Zip | 84341-2321
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Country | US
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Telephone | 435-770-3392
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Fax |
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Provider Business Mailing Address
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Address Line | 1219 N 400 E
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City | LOGAN
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State | UT
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Zip | 84341-2321
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Country | US
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Telephone | 435-770-3392
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. MATTHEW KIRK DANA
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Credential | D.C.
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Telephone | 435-770-3392
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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 | 8745261
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License Number State | UT
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