MEDICARE: MAYER CHIROPRACTIC AND WELLNESS PC

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	48735991202	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	:	1184618514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYER CHIROPRACTIC AND WELLNESS PC

Provider Business Mailing Address
First Line	:	926 W 1700 S
Second Line	:	SUITE B
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-8530
Country	:	US
Telephone Number	:	801-775-8880
Fax Number	:	801-775-8890

Provider Business Practice Location Address
First Line	:	926 W 1700 S
Second Line	:	SUITE B
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-8530
Country	:	US
Telephone Number	:	801-775-8880
Fax Number	:	801-775-8890

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRENT JAMES MAYER
Credential	:	DC
Telephone Number	:	801-773-8880

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	08/22/2020

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