1033302930 NPI number — WORKMAN CHIROPRACTIC CLINIC D.C. P.C.

Table of content: (NPI 1033302930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033302930 NPI number — WORKMAN CHIROPRACTIC CLINIC D.C. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORKMAN CHIROPRACTIC CLINIC D.C. P.C.
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:
1033302930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 N MAIN ST
Provider Second Line Business Mailing Address:
STE 207
Provider Business Mailing Address City Name:
CEDAR CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84720-2623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-865-9556
Provider Business Mailing Address Fax Number:
435-865-9570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 N MAIN ST
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-865-9556
Provider Business Practice Location Address Fax Number:
435-865-9570
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WORKMAN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
435-865-9556

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4782653-1202 , 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: 1821135583 . This is a "NPI" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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