1629430046 NPI number — DR. CHADWICK MILES DENSLEY D.O.

Table of content: DR. CHADWICK MILES DENSLEY D.O. (NPI 1629430046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629430046 NPI number — DR. CHADWICK MILES DENSLEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENSLEY
Provider First Name:
CHADWICK
Provider Middle Name:
MILES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1629430046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12842 SOUTH 3600 WEST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
RIVERTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12842 SOUTH 3600 WEST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
RIVERTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-285-4800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 6605082-1204 , 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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