Provider Demographics
NPI:1134792732
Name:SEVIER VALLEY SPORT AND SPINE PLLC
Entity type:Organization
Organization Name:SEVIER VALLEY SPORT AND SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:MECHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-893-6132
Mailing Address - Street 1:72 W PATRIOT WAY UNIT 1135
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1888
Mailing Address - Country:US
Mailing Address - Phone:435-289-3444
Mailing Address - Fax:
Practice Address - Street 1:72 W PATRIOT WAY UNIT 1135
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1888
Practice Address - Country:US
Practice Address - Phone:435-289-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center