Organization
SOUTH JORDAN HEALTH AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW PETERSON D.C. (PRESIDENT)
(435) 882-1621
Entity
Organization
Contact information
Practice address
272 N BROADWAY ST, #11, TOOELE, UT 84074-2244
(435) 882-1621
(435) 882-8267
Mailing address
272 N BROADWAY ST, #11, TOOELE, UT 84074-2244
(435) 882-1621
(435) 882-8267
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
370378-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3703781202
STATE LICENSE
UT
Enumeration date
08/30/2012
Last updated
06/27/2016
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