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General NPI Number Information
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NPI Number | 1982265534
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Entity Type | Individual
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Provider Name | JESS LELAND BLUTH DC
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Gender | Male
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 1684 W REUNION AVE STE 100
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-4609
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Country | US
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Telephone | 801-562-0502
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Fax | 801-302-8265
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Provider Business Mailing Address
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Address Line | 1684 W REUNION AVE STE 100
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-4609
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Country | US
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Telephone | 801-562-0502
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Fax | 801-302-8265
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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 | 9181282-1202
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License Number State | UT
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