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NPI Code Detail

MEDICARE: ASPEN FALLS SPINAL CARE CENTER LLC

MEDICARE: ASPEN FALLS SPINAL CARE CENTER 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
1111N00000XChiropractor67900091202KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11831383298OTHERKSINDIVIDUAL NPI NUMBER

General Provider Information

NPI Number : 1558517771
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASPEN FALLS SPINAL CARE CENTER LLC
Provider Business Mailing Address
First Line : 505 E 200 S
Second Line : STE 425
City : SALT LAKE CITY
State : UT
Zip : 84102-2022
Country : US
Telephone Number : 801-363-0060
Fax Number : 801-363-3926
Provider Business Practice Location Address
First Line : 505 E 200 S
Second Line : STE 425
City : SALT LAKE CITY
State : UT
Zip : 84102-2022
Country : US
Telephone Number : 801-363-0060
Fax Number : 801-363-3926
Authorized Official
Title or Position : OWNER
Name : DR. DUSTIN J HEDSTROM
Credential : D.C.
Telephone Number : 801-363-0060
Provider Enumeration Date : 08/08/2008
Last Update Date : 08/08/2008

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Directions to “ASPEN FALLS SPINAL CARE CENTER LLC ” Practice Location

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