MEDICARE: DR. SHON JAMES GOULDING 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	3452261202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	870569430	OTHER	UT	TAX ID
2	5290622	OTHER	UT	CNN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	107001659101	OTHER	UT	IHC

General Provider Information

NPI Number	:	1861433294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHON JAMES GOULDING DC

Provider Business Mailing Address
First Line	:	880 HERITAGE PARK BLVD
Second Line	:	SUITE 120
City	:	LAYTON
State	:	UT
Zip	:	84041-5676
Country	:	US
Telephone Number	:	801-614-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 HERITAGE PARK BLVD
Second Line	:	SUITE 120
City	:	LAYTON
State	:	UT
Zip	:	84041-5676
Country	:	US
Telephone Number	:	801-614-0550
Fax Number	:	801-614-0554

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/09/2008

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Directions to “ DR. SHON JAMES GOULDING DC” Practice Location

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