MEDICARE: DR. MICHAEL R EGBERT D.C., F.A.C.O.

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	111NX0800X	Orthopedic Chiropractor	160276-1202	UT

General Provider Information

NPI Number	:	1578529921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R EGBERT D.C., F.A.C.O.

Provider Business Mailing Address
First Line	:	7669 S 1700 W
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-4007
Country	:	US
Telephone Number	:	801-566-2449
Fax Number	:	801-566-5435

Provider Business Practice Location Address
First Line	:	7669 S 1700 W
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-4007
Country	:	US
Telephone Number	:	801-566-2449
Fax Number	:	801-566-5435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	08/22/2007

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