Organization
NECK AND BACK RELIEF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN JOSEPH COLARUSSO DC (OWNER/CEO)
(801) 878-3645
Entity
Organization
Contact information
Practice address
12600 S. 4013 W., SUITE E, RIVERTON, UT 84096
(801) 878-3645
(801) 878-3647
Mailing address
12600 S. 4013 W., SUITE E, RIVERTON, UT 84096
(801) 878-3645
(801) 878-3647
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5072634-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5072634-1202
UTAH LICENSE
UT
Enumeration date
12/20/2011
Last updated
12/20/2011
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