Provider Demographics
NPI:1063561009
Name:BURRUP, TRENT J (DC)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:J
Last Name:BURRUP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14043 FRIENDSHIP DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1787
Mailing Address - Country:US
Mailing Address - Phone:801-446-6981
Mailing Address - Fax:
Practice Address - Street 1:1847 W 9000 S STE 105
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8605
Practice Address - Country:US
Practice Address - Phone:801-567-0557
Practice Address - Fax:801-567-0546
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT267200-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor