Provider Demographics
NPI:1447713888
Name:AXON IOM LLC
Entity type:Organization
Organization Name:AXON IOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM, DC
Authorized Official - Phone:385-245-3580
Mailing Address - Street 1:1110 E 400 N
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1754
Mailing Address - Country:US
Mailing Address - Phone:385-245-3580
Mailing Address - Fax:
Practice Address - Street 1:1110 E 400 N
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1754
Practice Address - Country:US
Practice Address - Phone:385-245-3580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty