# NOORDA COLLEGE OF OSTEOPATHIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NOORDA COLLEGE OF OSTEOPATHIC
- **Other names:** NOORDA-COM HEALTH CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1871203414
- **Legal business name:** NOORDA COLLEGE OF OSTEOPATHIC
- **Authorized official:** JENNIFER SHUMWAY (DIRECTOR OF CLINICAL OPERATIONS)
- **Authorized official phone:** (801) 380-0015

## Contact information

- **Practice address:** 2162 SOUTH 180 EAST, STE 1000, PROVO, UT 84606
- **Practice address phone:** (385) 380-3425
- **Mailing address:** 2162 S 180 E STE 1000, PROVO, UT 84606-7370
- **Mailing address phone:** (385) 380-3425
- **Mailing address fax:** (855) 873-2517

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | NULL | Yes |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | Yes |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 12/05/2022
- **Last updated:** 11/26/2024