Organization · NPI-2

Cache Valley Chiropractic Clinic LLC

Chiropractor, Orthopedic · Providence, UT

NPI number1902943863
StatusActive
Last updated in NPPESMay 20, 2020

Details

NPI
1902943863
Entity type
Organization (NPI-2)
Legal business name
Cache Valley Chiropractic Clinic LLC
Organization subpart
No
Enumeration date
Jan 31, 2007
Certification date
May 20, 2020
Last updated
May 20, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
111NX0800X Chiropractor, Orthopedic169476-1202UTYes

Practice location

169 N Gateway Dr Ste 223
Providence, UT 84332-9856

Phone 435-752-2772 · Fax 435-752-2878

Mailing address

169 N Gateway Dr Ste 223
Providence, UT 84332-9856

Phone 435-752-7722 · Fax 435-752-2878

Other practice locations

755 S Main St
Suite #100
Logan, UT 84321-5402

Phone 435-752-2772

Authorized official

Neil Louis Erickson
Owner
4357522772

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