MEDICARE: STEPHEN MARK WHEELER DC

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	2903031202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204574521	OTHER	UT	TAX IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1619953254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN MARK WHEELER DC

Provider Business Mailing Address
First Line	:	5974 FASHION POINT DR
Second Line	:	SUITE 110
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-4699
Country	:	US
Telephone Number	:	801-621-1667
Fax Number	:	801-475-6802

Provider Business Practice Location Address
First Line	:	5974 FASHION POINT DR
Second Line	:	SUITE 110
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-4699
Country	:	US
Telephone Number	:	801-621-1667
Fax Number	:	801-475-6802

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	03/09/2010

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Directions to “ STEPHEN MARK WHEELER DC” Practice Location

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