Provider Demographics
NPI:1568634160
Name:TOTAL BODY CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:TOTAL BODY CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:435-783-2838
Mailing Address - Street 1:185 S MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-9597
Mailing Address - Country:US
Mailing Address - Phone:435-783-2838
Mailing Address - Fax:435-783-2840
Practice Address - Street 1:185 S MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-9597
Practice Address - Country:US
Practice Address - Phone:435-783-2838
Practice Address - Fax:435-783-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT67337OtherPEHP
UT50499451200001OtherREGENCE BCBS
UTQM0000056512OtherALTIUS
UT50499451277001OtherFEDERAL BCBS
UT870395551005Medicaid