Provider Demographics
NPI:1215979133
Name:COFER, DONALD A (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:COFER
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:PO BOX 680638
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-0638
Mailing Address - Country:US
Mailing Address - Phone:435-649-1542
Mailing Address - Fax:435-658-4909
Practice Address - Street 1:1901 PROSPECTOR AVE. STE 10
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060
Practice Address - Country:US
Practice Address - Phone:435-649-1542
Practice Address - Fax:435-658-4909
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT22-166999-1202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005813701Medicare ID - Type Unspecified
UTT98159Medicare UPIN