Provider Demographics
NPI:1134403629
Name:ALTA MOUNTAIN HEALTH & WELLNESS
Entity type:Organization
Organization Name:ALTA MOUNTAIN HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:ELDREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-569-8787
Mailing Address - Street 1:4692 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9035 S 1300 E
Practice Address - Street 2:SUITE 1B
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3132
Practice Address - Country:US
Practice Address - Phone:801-569-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5501297-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty