MEDICARE: CENTER FOR TEAM HEALTHCARE

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	111NX0800X	Orthopedic Chiropractor	221669991202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033396775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR TEAM HEALTHCARE

Provider Business Mailing Address
First Line	:	1901 PROSPECTOR AVE STE 10
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7550
Country	:	US
Telephone Number	:	435-649-1542
Fax Number	:	435-658-4909

Provider Business Practice Location Address
First Line	:	1901 PROSPECTOR AVE STE 10
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7207
Country	:	US
Telephone Number	:	435-649-1542
Fax Number	:	435-658-4909

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NATHAN J BLACK
Credential	:	D.C.
Telephone Number	:	435-649-1542

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	07/08/2019

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Directions to “CENTER FOR TEAM HEALTHCARE ” Practice Location

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