Provider Demographics
NPI:1730905076
Name:VISTA SPINE MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:VISTA SPINE MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-756-7800
Mailing Address - Street 1:1881 W TRAVERSE PKWY STE E534
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5986
Mailing Address - Country:US
Mailing Address - Phone:801-756-7800
Mailing Address - Fax:801-756-7805
Practice Address - Street 1:3000 N TRIUMPH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-7186
Practice Address - Country:US
Practice Address - Phone:801-756-7800
Practice Address - Fax:801-756-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty