MEDICARE: AGILITY 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	9793808-1202	UT

General Provider Information

NPI Number	:	1427584358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGILITY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1200 E 3300 S
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84106-2522
Country	:	US
Telephone Number	:	801-948-2850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 E 3300 S
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84106-2522
Country	:	US
Telephone Number	:	801-948-2850
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATHAN DAVID MCNEIL
Credential	:	D.C.
Telephone Number	:	801-948-2850

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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Directions to “AGILITY CHIROPRACTIC LLC ” Practice Location

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