Individual
NATHAN JEREMY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1901 PROSPECTOR AVE, PARK CITY, UT 84060-7207
(435) 649-1542
(435) 658-4909
Mailing address
PO BOX 680638, PARK CITY, UT 84068-0638
(435) 649-1542
(435) 658-4909
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
9242074-1202
UT
Other
Enumeration date
04/18/2018
Last updated
04/18/2018
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