Provider Demographics
NPI:1194957100
Name:CEDAR CITY CHIROPRACTIC AND REHABILITATION
Entity type:Organization
Organization Name:CEDAR CITY CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MURIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-867-6354
Mailing Address - Street 1:1180 SAGE DR STE E
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-4273
Mailing Address - Country:US
Mailing Address - Phone:435-867-6354
Mailing Address - Fax:
Practice Address - Street 1:1180 SAGE DR STE E
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-4273
Practice Address - Country:US
Practice Address - Phone:435-867-6354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT65174311202261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0408743273Medicaid
000063005Medicare PIN