Individual
DR. KEAGAN TICE SMALLWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
912 W BAXTER DR STE 130, SOUTH JORDAN, UT 84095-5876
(385) 308-4355
Mailing address
912 W BAXTER DR STE 130, SOUTH JORDAN, UT 84095-5876
(853) 084-3553
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
123902991202
UT
111N00000X
Chiropractor
14500
TX
Other
Enumeration date
09/21/2020
Last updated
08/02/2023
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