Provider Demographics
NPI:1447834882
Name:UTAH CHIRO SPORT, L.L.C.
Entity type:Organization
Organization Name:UTAH CHIRO SPORT, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUMOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-255-0665
Mailing Address - Street 1:8846 S REDWOOD RD
Mailing Address - Street 2:SUITE N-103
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088
Mailing Address - Country:US
Mailing Address - Phone:801-255-0665
Mailing Address - Fax:
Practice Address - Street 1:8846 S REDWOOD RD
Practice Address - Street 2:SUITE N-103
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8408
Practice Address - Country:US
Practice Address - Phone:801-255-0665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty