| Salt Lake Sports Chiropractic | |
|
3980 S 700 E Ste 23 Salt Lake City UT 84107-2530 | |
| (801) 456-0350 | |
| (801) 456-0351 |
| Full Name | Salt Lake Sports Chiropractic |
|---|---|
| Speciality | Clinic/Center |
| Location | 3980 S 700 E Ste 23, Salt Lake City, Utah |
| Authorized Official Name and Position | Bradley Alan Anderson (OWNER) |
| Authorized Official Contact | 3604024840 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Salt Lake Sports Chiropractic 3980 S 700 E Ste 23 Salt Lake City UT 84107-2530 Ph: (801) 456-0350 | Salt Lake Sports Chiropractic 3980 S 700 E Ste 23 Salt Lake City UT 84107-2530 Ph: (801) 456-0350 |
| NPI Number | 1508103193 |
|---|---|
| Provider Enumeration Date | 01/15/2013 |
| Last Update Date | 01/23/2018 |
| Medicare PECOS PAC ID | 7113171653 |
|---|---|
| Medicare Enrollment ID | O20130208000147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508103193 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 8536046-1202 (Utah) | Primary |
| Provider Name | Bradley Alan Anderson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1790022382 PECOS PAC ID: 8022262567 Enrollment ID: I20130208000248 |
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