Provider Demographics
NPI:1215154034
Name:MT. GIBBORIM, PLLC
Entity type:Organization
Organization Name:MT. GIBBORIM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
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
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3266
Mailing Address - Country:US
Mailing Address - Phone:435-635-7771
Mailing Address - Fax:435-635-7701
Practice Address - Street 1:83 S 2600 W
Practice Address - Street 2:SUITE 102
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3266
Practice Address - Country:US
Practice Address - Phone:435-635-7771
Practice Address - Fax:435-635-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60040551202111N00000X, 111N00000X
UT65174311202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000058166Medicare PIN