| NPI | 1215702634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYFFANI C JACKSON Managing Member 801-899-3904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic |
| Additional Taxonomies | 111N00000X Chiropractor |
| 111NR0400X | |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2023-11-15 |