Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 161157-1202 | UT |
NPI | 1730138470 |
---|---|
Provider Name | Dr. Kelly B Jarvis SR. |
First Address | Heber, UT 84032-3938 |
Second Address | Heber City, UT 84032-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 29/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T48877 | (02) | UT |