MEDICARE: BODY RIGHT CHIORPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5188221-1202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51882211203001	OTHER	UT	BCBS OF UTAH

General Provider Information

NPI Number	:	1013021468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY RIGHT CHIORPRACTIC INC

Provider Business Mailing Address
First Line	:	2179 W 1800 N STE C2
Second Line	:
City	:	CLINTON
State	:	UT
Zip	:	84015-7900
Country	:	US
Telephone Number	:	801-614-0166
Fax Number	:	801-614-0167

Provider Business Practice Location Address
First Line	:	2179 W 1800 N STE C2
Second Line	:
City	:	CLINTON
State	:	UT
Zip	:	84015-7900
Country	:	US
Telephone Number	:	801-614-0166
Fax Number	:	801-614-0167

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MR. RYAN A ATKINSON
Credential	:	DC
Telephone Number	:	801-614-0166

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	12/12/2008

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Directions to “BODY RIGHT CHIORPRACTIC INC ” Practice Location

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