1821266784 NPI number — HIGHLAND CHIROPRACTIC CLINIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821266784 NPI number — HIGHLAND CHIROPRACTIC CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLAND CHIROPRACTIC CLINIC, 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:
HIGHLAND CHIROPRACTIC CLINIC
Provider Other Organization Name Type Code:
3
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:
1821266784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4646 HIGHLAND DR
Provider Second Line Business Mailing Address:
ST 101
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84117-5135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-277-5665
Provider Business Mailing Address Fax Number:
801-277-5666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4646 HIGHLAND DR
Provider Second Line Business Practice Location Address:
ST 101
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:
84117-5135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-277-5665
Provider Business Practice Location Address Fax Number:
801-277-5666
Provider Enumeration Date:
02/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
SAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
801-277-5665

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  363476-1202 , 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)





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