Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 116590951202 | UT |
NPI | 1144844523 |
---|---|
Provider Name | Richard Mason Stewart III |
First Address | Sandy, UT 84070-6555 |
Second Address | Draper, UT 84020-9834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2020 |
Last Update Date | 02/06/2020 |