MEDICARE: SUPERIOR WELLNESS LLC

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

General Provider Information

NPI Number	:	1033826185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR WELLNESS LLC

Provider Business Mailing Address
First Line	:	8170 S HIGHLAND DR STE E4
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6465
Country	:	US
Telephone Number	:	801-942-4999
Fax Number	:	801-942-8816

Provider Business Practice Location Address
First Line	:	8170 S HIGHLAND DR STE E4
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6465
Country	:	US
Telephone Number	:	801-942-4999
Fax Number	:	801-942-8816

Authorized Official
Title or Position	:	OWNER
Name	:	KALI KRIVINCHUK
Credential	:	DC
Telephone Number	:	218-343-7173

Provider Enumeration Date	:	10/28/2022
Last Update Date	:	10/28/2022

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Directions to “SUPERIOR WELLNESS LLC ” Practice Location

Language	Start Address	Practice Location

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