MEDICARE: CENTER FOR CHIROPRACTIC HEALTH CARE

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	52829301202	UT

General Provider Information

NPI Number	:	1801908090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR CHIROPRACTIC HEALTH CARE

Provider Business Mailing Address
First Line	:	5204 S REDWOOD RD
Second Line	:	SUITE B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-4217
Country	:	US
Telephone Number	:	801-417-5700
Fax Number	:	801-417-5702

Provider Business Practice Location Address
First Line	:	5204 S REDWOOD RD
Second Line	:	SUITE B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123
Country	:	US
Telephone Number	:	801-417-5700
Fax Number	:	801-417-5702

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	LANCE WILLIAM WALKER
Credential	:	D.C.
Telephone Number	:	801-417-5700

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/17/2007

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