Evergreen Chiropractic, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5289181-1202 Issued in UT

Legal business name

EVERGREEN CHIROPRACTIC, PLLC

Practice address

1445 N 1200 W
Orem, UT 84057-2449

Phone

(801) 224-2279

Fax

(801) 224-2381

NPI assigned

Aug 4, 2008

Last updated

Aug 4, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Geoffrey G. Moultrie, D.C.

Title

Owner

Phone

(801) 224-2279

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1316103864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 N 1200 W",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840572449",
            "telephone_number": "801-224-2279",
            "fax_number": "801-224-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 N 1200 W",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840572449",
            "telephone_number": "801-224-2279",
            "fax_number": "801-224-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "MOULTRIE",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-224-2279",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "5289181-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.