1396867479 NPI number — CHRIS WEHL, PH.D., INC.

Table of content: (NPI 1396867479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396867479 NPI number — CHRIS WEHL, PH.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRIS WEHL, PH.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396867479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 E 200 S
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84102-2022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-350-0115
Provider Business Mailing Address Fax Number:
801-350-9582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 E 200 S
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84102-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-350-0115
Provider Business Practice Location Address Fax Number:
801-350-9582
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EINING
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
801-350-3503

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  115392-2501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 562921865004 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: U000572 . This is a "TRICARE PROVIDER ID" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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