Provider Demographics
NPI:1174756738
Name:PREMIER CHIROPRACTIC
Entity type:Organization
Organization Name:PREMIER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MCPHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-882-0906
Mailing Address - Street 1:294 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2723
Mailing Address - Country:US
Mailing Address - Phone:435-882-0906
Mailing Address - Fax:
Practice Address - Street 1:2530 W 4700 S
Practice Address - Street 2:SUITE B4
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-1865
Practice Address - Country:US
Practice Address - Phone:801-884-9126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT73967271202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center