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NPI Code Detail

MEDICARE: REGAN JAY ARCHIBALD LAC.

MEDICARE: REGAN JAY ARCHIBALD LAC.
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
1171100000XAcupuncturist20041684UT

General Provider Information

NPI Number : 1164623765
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGAN JAY ARCHIBALD LAC.
Provider Business Mailing Address
First Line : 34 S 500 E STE 103
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-1094
Country : US
Telephone Number : 801-582-2011
Fax Number : 801-359-8478
Provider Business Practice Location Address
First Line : 34 S 500 E STE 103
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-1094
Country : US
Telephone Number : 801-582-2011
Fax Number : 801-359-8478
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2007
Last Update Date : 07/08/2007

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Directions to “ REGAN JAY ARCHIBALD LAC.” Practice Location

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