MEDICARE: CANYONLANDS NATURAL MEDICINE

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	175F00000X	Naturopath

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891246922	OTHER	UT	NPI
2	1811439987	OTHER	UT	NPI

General Provider Information

NPI Number	:	1265068472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANYONLANDS NATURAL MEDICINE

Provider Business Mailing Address
First Line	:	1174 S FOOTHILL DR APT 433
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1958
Country	:	US
Telephone Number	:	920-273-5565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 S MAIN ST STE 13
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-7051
Country	:	US
Telephone Number	:	801-441-0549
Fax Number	:	801-901-8525

Authorized Official
Title or Position	:	STAFF PHYSICIAN
Name	:	DR. DANIEL REED
Credential	:	NMD
Telephone Number	:	801-441-0549

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	03/19/2020

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Directions to “CANYONLANDS NATURAL MEDICINE ” Practice Location

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