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NPI Code Detail

MEDICARE: ADJUST YOUR LIFE - CHIROPRACTIC

MEDICARE: ADJUST YOUR LIFE - CHIROPRACTIC
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
1111N00000XChiropractor6796488-1202UT

General Provider Information

NPI Number : 1053586131
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADJUST YOUR LIFE - CHIROPRACTIC
Provider Business Mailing Address
First Line : 146 E 4600 S
Second Line :
City : WASHINGTON TERRACE
State : UT
Zip : 84405-5946
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 146 E 4600 S
Second Line :
City : WASHINGTON TERRACE
State : UT
Zip : 84405-5946
Country : US
Telephone Number : 801-627-2023
Fax Number :
Authorized Official
Title or Position : DOCTOR/DIRECTOR
Name : BLAKE FENTON
Credential : D.C.
Telephone Number : 801-627-2023
Provider Enumeration Date : 04/29/2008
Last Update Date : 04/29/2008

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Directions to “ADJUST YOUR LIFE - CHIROPRACTIC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.