Provider Demographics
NPI:1396918686
Name:SORENSON, JOHN ROBERT (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:SORENSON
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 1:720 S RIVER RD STE C240
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2103
Mailing Address - Country:US
Mailing Address - Phone:435-656-2888
Mailing Address - Fax:435-656-8400
Practice Address - Street 1:720 S RIVER RD STE C240
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2103
Practice Address - Country:US
Practice Address - Phone:435-656-2888
Practice Address - Fax:435-656-8400
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23114111N00000X
UT6799308-8007111N00000X
UT6799308-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU70025Medicare UPIN