Organization · NPI-2

Beecon Of Light

Clinic/Center · Brigham City, UT

NPI number1689337396
StatusActive
Last updated in NPPESOct 19, 2021

Details

NPI
1689337396
Entity type
Organization (NPI-2)
Legal business name
Beecon Of Light
Organization subpart
No
Enumeration date
Oct 19, 2021
Certification date
Oct 19, 2021
Last updated
Oct 19, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

60 S Main St # B002
Brigham City, UT 84302-6719

Phone 435-239-8768

Mailing address

60 S Main St # B002
Brigham City, UT 84302-6719

Authorized official

Anthony Pool
Owner
4352398768

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