Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1676421202 | UT |
NPI | 1750388765 |
---|---|
Provider Name | Patrick Egbert |
First Address | West Jordan, UT 84084-4007 |
Second Address | West Jordan, UT 84084-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 23/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T78056 | (02) | UT |