Individual
Inactive
Sole proprietor
Provider details
NPI number
Contact information
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4806041-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214913
ALTIUS
UT
Enumeration date
—
Last updated
—
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