Individual
NIXON DORVILIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1420 S 500 W, SALT LAKE CITY, UT 84115-5149
(347) 640-2344
Mailing address
1420 S 500 W, SALT LAKE CITY, UT 84115-5149
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
10105665-4810
UT
Other
Enumeration date
12/16/2017
Last updated
12/16/2017
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