Provider Demographics
NPI:1447299557
Name:SOUTHAM, JOHN DEVIN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DEVIN
Last Name:SOUTHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 N 1200 W
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-3341
Mailing Address - Country:US
Mailing Address - Phone:435-789-0606
Mailing Address - Fax:435-789-0233
Practice Address - Street 1:975 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2400
Practice Address - Country:US
Practice Address - Phone:435-789-0704
Practice Address - Fax:435-789-0233
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT97-334970-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor