Sports Chiropractic of Utah LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

SPORTS CHIROPRACTIC OF UTAH LLC

Practice address

6717 S 900 E Ste 101
Midvale, UT 84047-5755

Phone

(406) 381-7577

NPI assigned

Aug 30, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jordan Mousley, D.C.NPI 1013465632

Title

Owner

Phone

(406) 381-7577

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jordan Mousley, D.C.

  • Chiropractor
  • Midvale, UT
  • NPI 1013465632
  Medicare reassignment Authorized official
• Andrew J Reheisse, D.C.

  • Sports Physician Chiropractor
  • Murray, UT
  • NPI 1003217449
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1104372184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6717 S 900 E STE 101",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840475755",
            "telephone_number": "406-381-7577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6717 S 900 E STE 101",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840475755",
            "telephone_number": "406-381-7577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS CHIROPRACTIC OF UTAH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-30",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "MOUSLEY",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-381-7577",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Mountain PT & Rehabilitation
• Lisa Sovinsky, LCSW
• Specialized Pharmacy Services
• Rachael Spence
• Sports Chiropractic and Wellness Center PC
• Spring Gardens Midvale Opco LLC
• Corinne Sroykum
• Marsha Kay Stafford, SUDC, LPP
• Madison Staples, M.S., CF-SLP
• Michael Stapley, PHARMD

• Chiropractor in Midvale, UT
• Providers in Midvale, UT by specialty
• Chiropractor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.