Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 9407716-1202 | UT |
NPI | 1265816953 |
---|---|
Provider Name | Dr. Jordan Karl Mecham |
First Address | Delta, UT 84624-5551 |
Second Address | Delta, UT 84624-5551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2015 |
Last Update Date | 13/08/2015 |