Provider Demographics
NPI:1780076703
Name:NON SURGICAL SPINE TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:NON SURGICAL SPINE TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-785-6534
Mailing Address - Street 1:405 S 100 E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2751
Mailing Address - Country:US
Mailing Address - Phone:801-785-6534
Mailing Address - Fax:888-431-2763
Practice Address - Street 1:405 S 100 E
Practice Address - Street 2:SUITE 102
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2751
Practice Address - Country:US
Practice Address - Phone:801-785-6534
Practice Address - Fax:888-431-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1684541202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty