Provider Demographics
NPI:1346386133
Name:UTAH VALLEY SPINAL HEALTH LLC
Entity type:Organization
Organization Name:UTAH VALLEY SPINAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR CLINIC OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:801-623-4740
Mailing Address - Street 1:3507 N UNIVERSITY AVE
Mailing Address - Street 2:STE 175
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4478
Mailing Address - Country:US
Mailing Address - Phone:801-623-7470
Mailing Address - Fax:801-623-4741
Practice Address - Street 1:3507 N UNIVERSITY AVE
Practice Address - Street 2:STE 175
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4478
Practice Address - Country:US
Practice Address - Phone:801-623-7470
Practice Address - Fax:801-623-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6055471-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty