Provider Demographics
NPI:1861419608
Name:ALPINE HEALTH AND REHABILITATION CENTER LC
Entity type:Organization
Organization Name:ALPINE HEALTH AND REHABILITATION CENTER LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-565-1155
Mailing Address - Street 1:1745 W 7800 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4017
Mailing Address - Country:US
Mailing Address - Phone:801-565-1155
Mailing Address - Fax:801-565-1157
Practice Address - Street 1:1745 W 7800 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4017
Practice Address - Country:US
Practice Address - Phone:801-565-1155
Practice Address - Fax:801-565-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5896405-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty