MEDICARE: CAPSTONE CHIROPRACTIC LLC

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	9246735-1202	UT

General Provider Information

NPI Number	:	1326432766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPSTONE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2200 E 4500 S
Second Line	:	STE 110
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4437
Country	:	US
Telephone Number	:	801-272-8500
Fax Number	:	801-272-3562

Provider Business Practice Location Address
First Line	:	2200 E 4500 S
Second Line	:	STE 110
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4437
Country	:	US
Telephone Number	:	801-272-8500
Fax Number	:	801-272-3562

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. RYAN JAMES ROWELL
Credential	:	D.C.
Telephone Number	:	801-272-8500

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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