Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 292680-1202 | UT |
NPI | 1003831223 |
---|---|
Provider Name | Dr. Dan Egbert |
First Address | Riverton, UT 84065-7111 |
Second Address | Riverton, UT 84065-7111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
870395551005 | (05) | UT |
U31603 | (02) | UT |