Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 294407-1202 | UT |
NPI | 1003959081 |
---|---|
Provider Name | Rendon Jess Hughes |
First Address | Delta, UT 84624-1173 |
Second Address | Delta, UT 84624-1173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U57166 | (02) | UT |