MEDICARE: SCRANTON CLINIC OF 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
1	111N00000X	Chiropractor	8689336-1202	UT

General Provider Information

NPI Number	:	1215245881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCRANTON CLINIC OF CHIROPRACTIC

Provider Business Mailing Address
First Line	:	4775 W. DAYBREAK PARKWAY
Second Line	:	ST. 102
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095
Country	:	US
Telephone Number	:	309-737-1534
Fax Number	:	432-204-3527

Provider Business Practice Location Address
First Line	:	4775 W. DAYBREAK PARKWAY
Second Line	:	ST. 102
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095
Country	:	US
Telephone Number	:	309-737-1534
Fax Number	:	432-204-3527

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT J SCRANTON
Credential	:	D.C.
Telephone Number	:	309-230-3971

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	01/27/2014

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