Organization
CHIRO-ACTIVE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN BRUCE TRAVELLER D.C. (OWNER)
(435) 563-4772
Entity
Organization
Contact information
Practice address
3935 N 75 W, HYDE PARK, UT 84318-4111
(435) 563-4772
Mailing address
3935 N 75 W, HYDE PARK, UT 84318-4111
(435) 563-4772
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
6859851-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6859851-1202
LICENSE
UT
Enumeration date
02/12/2008
Last updated
03/03/2008
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