Provider Demographics
NPI:1861433294
Name:GOULDING, SHON JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:SHON
Middle Name:JAMES
Last Name:GOULDING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 HERITAGE PARK BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5676
Mailing Address - Country:US
Mailing Address - Phone:801-614-0550
Mailing Address - Fax:
Practice Address - Street 1:880 HERITAGE PARK BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5676
Practice Address - Country:US
Practice Address - Phone:801-614-0550
Practice Address - Fax:801-614-0554
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3452261202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870569430OtherTAX ID
UT5290622OtherCNN
UT870395551005Medicaid
UT107001659101OtherIHC
UT350046464Medicare PIN
UT5290622OtherCNN
UTZ21290Medicare UPIN