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NPI Code Detail

MEDICARE: SPORT SPINE & WELLNESS, PLLC

MEDICARE: SPORT SPINE & WELLNESS, PLLC
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
1111NS0005XSports Physician Chiropractor8536048-1202UT

General Provider Information

NPI Number : 1942541222
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPORT SPINE & WELLNESS, PLLC
Provider Business Mailing Address
First Line : 1664 S DIXIE DR
Second Line : STE. F-103
City : ST GEORGE
State : UT
Zip : 84770-7327
Country : US
Telephone Number : 435-703-9676
Fax Number :
Provider Business Practice Location Address
First Line : 1664 S DIXIE DR
Second Line : STE. F-103
City : ST GEORGE
State : UT
Zip : 84770-7327
Country : US
Telephone Number : 435-703-9676
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MIKEL RICHTER
Credential : D.C.
Telephone Number : 435-703-9676
Provider Enumeration Date : 03/11/2013
Last Update Date : 03/11/2013

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Directions to “SPORT SPINE & WELLNESS, PLLC ” Practice Location

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