Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 160276-1202 | UT |
NPI | 1578529921 |
---|---|
Provider Name | Dr. Michael R Egbert |
First Address | West Jordan, UT 84084-4007 |
Second Address | West Jordan, UT 84084-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 22/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T48893 | (02) | UT |