MEDICARE: SPINAL CARE MANAGEMENT, INC.

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

General Provider Information

NPI Number	:	1275664948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINAL CARE MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	505 E 200 S
Second Line	:	SUITE 425
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2022
Country	:	US
Telephone Number	:	801-363-0060
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 E 200 S
Second Line	:	SUITE 425
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2022
Country	:	US
Telephone Number	:	801-363-0060
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DIANNE WYGANT
Credential	:
Telephone Number	:	801-301-0351

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	10/16/2007

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