Organization
AXIAL-IM
Active
Other names
Axial Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLIE S WILSON (AUTHORIZED OFFICIAL)
(913) 499-9885
Entity
Organization
Contact information
Practice address
3898 W INNOVATION DR STE B, RIVERTON, UT 84065-6038
(801) 302-0660
(801) 302-2239
Mailing address
PO BOX 95411, SOUTH JORDAN, UT 84095-0411
(801) 210-2776
(801) 972-5707
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
—
—
2251N0400X
Neurology Physical Therapist
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
04/17/2019
Last updated
03/05/2025
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