Provider Demographics
NPI:1548532740
Name:TIMPANOGOS CHIROPRACTIC & WELLNESS CENTER, L.L.C.
Entity type:Organization
Organization Name:TIMPANOGOS CHIROPRACTIC & WELLNESS CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HARLAN
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-796-7075
Mailing Address - Street 1:28 N 100 E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2302
Mailing Address - Country:US
Mailing Address - Phone:801-796-7075
Mailing Address - Fax:801-796-7085
Practice Address - Street 1:28 N 100 E
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2302
Practice Address - Country:US
Practice Address - Phone:801-796-7075
Practice Address - Fax:801-796-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT334676-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty