Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111N00000X | Chiropractor | | 149169-1202 | UTAH | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 870496123 | OTHER | UTAH | CHICAGO LABORERS HEALTH |
| 2 | 870496123 | OTHER | UTAH | MAIL HANDELERS |
| 3 | 870496123 | OTHER | UTAH | STANDARD LIFE |
| 4 | 35281 | OTHER | UTAH | DMBA |
| 5 | 870496123 | OTHER | UTAH | BANKERS LIFE |
| 6 | 870496123 | OTHER | UTAH | CCNM |
| 7 | 870496123 | OTHER | UTAH | LIBERTY MUTUIAL |
| 8 | UT9999 | OTHER | UTAH | MUTUAL OF OMAHA |
| 9 | 000005564 | MEDICARE ID-TYPE UNSPECIFIED | UTAH | |
| 10 | 870496123 | OTHER | UTAH | GREAT WEST |
| 11 | 870496123 B96840 | OTHER | UTAH | BLUE CROSS BLU SHIELD UT |
| 12 | 107000307101 | OTHER | UTAH | SELECT CARE |
| 13 | 870496123 | OTHER | UTAH | PRINCIPAL LIFE |
| 14 | 870496123 001 | OTHER | UTAH | CIGNA |
