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General NPI Number Information
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NPI Number | 1992174148
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Entity Type | Organization
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Legal Business Name | JOINT AND SPINE CARE CENTER OF UTAH
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 2195 W 5400 S STE 105
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-1431
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Country | US
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Telephone | 801-964-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 2195 W 5400 S STE 105
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-1431
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Country | US
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Telephone | 801-964-2400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DERRICK STANBRIDGE
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Credential | DC
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Telephone | 801-458-0152
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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 | 48011471202
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License Number State | UT
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