Provider Demographics
NPI:1104692375
Name:UINTA SPINE ALIGN
Entity type:Organization
Organization Name:UINTA SPINE ALIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-222-4322
Mailing Address - Street 1:1425 HIGHWAY 150 S STE 2
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5377
Mailing Address - Country:US
Mailing Address - Phone:307-222-4322
Mailing Address - Fax:307-444-4325
Practice Address - Street 1:1425 HIGHWAY 150 S STE 2
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5377
Practice Address - Country:US
Practice Address - Phone:307-222-4322
Practice Address - Fax:307-444-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty