Provider Demographics
NPI:1902212806
Name:INJURY RECOVERY SPECIALISTS
Entity type:Organization
Organization Name:INJURY RECOVERY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:801-376-9596
Mailing Address - Street 1:1437 W MIDAS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7879
Mailing Address - Country:US
Mailing Address - Phone:801-376-9596
Mailing Address - Fax:801-907-7574
Practice Address - Street 1:1437 W MIDAS CREEK DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7879
Practice Address - Country:US
Practice Address - Phone:801-376-9596
Practice Address - Fax:801-907-7574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRALINE CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6715760-1202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE