Provider Demographics
NPI:1548539554
Name:NECK AND BACK RELIEF
Entity type:Organization
Organization Name:NECK AND BACK RELIEF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COLARUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-878-3645
Mailing Address - Street 1:12600 S. 4013 W.
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096
Mailing Address - Country:US
Mailing Address - Phone:801-878-3645
Mailing Address - Fax:801-878-3647
Practice Address - Street 1:12600 S. 4013 W.
Practice Address - Street 2:SUITE E
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096
Practice Address - Country:US
Practice Address - Phone:801-878-3645
Practice Address - Fax:801-878-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5072634-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5072634-1202OtherUTAH LICENSE