Provider Demographics
NPI:1548530124
Name:TAYLORSVILLE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:TAYLORSVILLE CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSENGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-969-4700
Mailing Address - Street 1:1951 W 4700 S
Mailing Address - Street 2:STE 3
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-1108
Mailing Address - Country:US
Mailing Address - Phone:801-969-4700
Mailing Address - Fax:801-969-7217
Practice Address - Street 1:1951 W 4700 S
Practice Address - Street 2:STE 3
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1108
Practice Address - Country:US
Practice Address - Phone:801-969-4700
Practice Address - Fax:801-969-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service