Provider Demographics
NPI:1871893172
Name:BRIGHAM CITY CHIROPRACTIC & ACCIDENT REHABILITATION
Entity type:Organization
Organization Name:BRIGHAM CITY CHIROPRACTIC & ACCIDENT REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-400-5043
Mailing Address - Street 1:1264 N 500 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2929
Mailing Address - Country:US
Mailing Address - Phone:801-400-5043
Mailing Address - Fax:
Practice Address - Street 1:75 E 600 S
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3227
Practice Address - Country:US
Practice Address - Phone:435-734-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty