MEDICARE: DR. GREGORY DEFOREST FUTRELL DC

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	2897831202	UT

General Provider Information

NPI Number	:	1124100219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY DEFOREST FUTRELL DC

Provider Business Mailing Address
First Line	:	7050 HIGHLAND DR STE 140
Second Line	:
City	:	SALT LAKE CTY
State	:	UT
Zip	:	84121-3763
Country	:	US
Telephone Number	:	801-944-8700
Fax Number	:	801-944-0688

Provider Business Practice Location Address
First Line	:	7050 HIGHLAND DR STE 140
Second Line	:
City	:	SALT LAKE CTY
State	:	UT
Zip	:	84121-3763
Country	:	US
Telephone Number	:	801-944-8700
Fax Number	:	801-944-0688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/20/2007

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