Provider Demographics
NPI:1174057277
Name:INTERMOUNTAIN HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:INTERMOUNTAIN HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:SPIERS
Authorized Official - Last Name:LUDDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-981-8795
Mailing Address - Street 1:7430 S CREEK RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6158
Mailing Address - Country:US
Mailing Address - Phone:801-981-8795
Mailing Address - Fax:801-987-8051
Practice Address - Street 1:7430 S CREEK RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6158
Practice Address - Country:US
Practice Address - Phone:801-981-8795
Practice Address - Fax:801-987-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48060411202111N00000X
UT1686321205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty