Provider Demographics
NPI:1437994845
Name:WINN, RICHARD MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MATTHEW
Last Name:WINN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 W 9000 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9219
Mailing Address - Country:US
Mailing Address - Phone:801-541-2902
Mailing Address - Fax:
Practice Address - Street 1:1573 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9219
Practice Address - Country:US
Practice Address - Phone:801-541-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13754571-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor