Advanced Injury Rehabilitation, LLC
Organization Active NPI Chiropractor · Ogden, UT
NPI 1134473267 · NPPES record last updated Mar 20, 2024
Key facts
- NPI
- 1134473267
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 294900-1202 (UT)
- Legal business name
- ADVANCED INJURY REHABILITATION, LLC
- Practice address
- 1920 W 250 N
Ste 24
Ogden, UT 84404-9233 - Phone
- (801) 317-4757
- Fax
- (801) 605-3439
- NPI assigned
- Oct 26, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Allen Lawes
- Title
- Owner
- Phone
- (801) 317-4757
Practitioners 2
-
Peter R Raether, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130123000573 | UT | Part B Supplier - Clinic/Group Practice | 8022261189 |
Receives reassigned benefits from 1 practitioner Practice locations: Ogden, UT |
National Provider Directory
Locations
1920 W 250 N
Ogden, UT 84404
Phone (435) 723-4500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 294900-1202 | UT | Yes |
Addresses
Primary practice location
1920 W 250 N
Ste 24
Ogden, UT 84404-9233
Mailing address
1920 W 250 N
Ste 24
Ogden, UT 84404-9233
Phone (801) 317-4757
Other names
- Pioneer Chiropractic Wellness
Other providers in Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.