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NPI Code Detail

MEDICARE: MOUNT LOGAN CHIROPRACTIC INC

MEDICARE: MOUNT LOGAN CHIROPRACTIC INC
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
1302F00000XExclusive Provider Organization4788778-1202UT

General Provider Information

NPI Number : 1740553510
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNT LOGAN CHIROPRACTIC INC
Provider Business Mailing Address
First Line : 267 N SPRING CREEK PKWY
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9775
Country : US
Telephone Number : 435-792-9400
Fax Number : 435-792-4800
Provider Business Practice Location Address
First Line : 267 N SPRING CREEK PKWY
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9775
Country : US
Telephone Number : 435-792-9400
Fax Number : 435-792-4800
Authorized Official
Title or Position : OWNER/CHIROPRACTOR
Name : STEVEN SCOTT GARVERT
Credential : DC.
Telephone Number : 435-792-9400
Provider Enumeration Date : 02/09/2012
Last Update Date : 03/29/2012

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Directions to “MOUNT LOGAN CHIROPRACTIC INC ” Practice Location

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