Provider Demographics
NPI:1104345636
Name:CORAL CANYON JOINT & SPINE HEALTH
Entity type:Organization
Organization Name:CORAL CANYON JOINT & SPINE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-635-7771
Mailing Address - Street 1:83 S 2600 W STE 102
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3268
Mailing Address - Country:US
Mailing Address - Phone:435-635-7771
Mailing Address - Fax:
Practice Address - Street 1:83 S 2600 W STE 102
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3268
Practice Address - Country:US
Practice Address - Phone:435-635-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty