Provider Demographics
NPI:1285728899
Name:HOUGAARD, BRYCE (DC)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:HOUGAARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRYCE
Other - Middle Name:
Other - Last Name:HOUGAARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84326-0005
Mailing Address - Country:US
Mailing Address - Phone:435-232-4279
Mailing Address - Fax:888-668-5207
Practice Address - Street 1:1068 W SOUTH JORDAN PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8882
Practice Address - Country:US
Practice Address - Phone:801-523-8700
Practice Address - Fax:801-523-8191
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176437-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT68-0533648OtherTAX ID # FOR PRACTICE