Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7759187-1202 | UT |
NPI | 1003125964 |
---|---|
Provider Name | Dr. Jason North |
First Address | Springville, UT 84663 |
Second Address | Springville, UT 84663-4013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2010 |
Last Update Date | 27/09/2010 |