Provider Demographics
NPI:1043673825
Name:UTAH UPPER CERVICAL CHIROPRACTIC
Entity type:Organization
Organization Name:UTAH UPPER CERVICAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FOREST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-692-6880
Mailing Address - Street 1:33 N 470 W
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2267
Mailing Address - Country:US
Mailing Address - Phone:801-692-6880
Mailing Address - Fax:
Practice Address - Street 1:33 N 470 W
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2267
Practice Address - Country:US
Practice Address - Phone:801-692-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9567321-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty