# AXIAL-IM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Axial Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740843697
- **Authorized official:** MOLLIE S WILSON (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (913) 499-9885

## Contact information

- **Practice address:** 3898 W INNOVATION DR STE B, RIVERTON, UT 84065-6038
- **Practice address phone:** (801) 302-0660
- **Practice address fax:** (801) 302-2239
- **Mailing address:** PO BOX 95411, SOUTH JORDAN, UT 84095-0411
- **Mailing address phone:** (801) 210-2776
- **Mailing address fax:** (801) 972-5707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | NULL | Yes |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | Yes |
| 2251N0400X | Neurology Physical Therapist | — | NULL | — |
| 2251N0400X | Neurology Physical Therapist | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/17/2019
- **Last updated:** 03/05/2025