NPIMap

Organization Active NPI

Theodore L Conger D.C., Inc

Doing business as Conger Chiropractic Clinic

  • Chiropractor
  • Salt Lake City, UT
National Provider Identifier
1386859817
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
171096-1202 Issued in UT
Legal business name
THEODORE L CONGER D.C., INC
Doing business as
Conger Chiropractic Clinic
Practice address
747 E South Temple Ste 200
Salt Lake City, UT 84102-1217
Phone
(801) 530-4802
Fax
(801) 530-0146
NPI assigned
May 10, 2007
Last updated
May 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2020

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

Authorized official

Name
Dr. Theodore L Conger, D.C.NPI 1588676738
Title
Physician, President
Phone
(801) 530-4802

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 171096-1202 UT Primary

Addresses

Primary practice location

747 E South Temple Ste 200
Salt Lake City, UT 84102-1217

Mailing address

747 E South Temple Ste 200
Salt Lake City, UT 84102-1217
Phone (801) 530-4802

Other identifiers 2

IdentifierTypeStateIssuer
534647011005MedicaidUT
4550443OtherUTAETNA

Other names 1

  • Conger Chiropractic Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031206000113 UT Part B Supplier - Clinic/Group Practice 2163327628 Receives reassigned benefits from 1 practitioner
Practice locations: Salt Lake City, UT

National Provider Directory

National Provider Directory

Locations

747 E South Temple
Ste 200
Salt Lake City, UT 84102
Phone (801) 530-4802

2200 E 4500 S
Ste 110
Salt Lake Cty, UT 84117
Phone (801) 272-8500

479 E 500 S
Salt Lake Cty, UT 84111
Phone (385) 234-8732

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1386859817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 E SOUTH TEMPLE STE 200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021217",
            "telephone_number": "801-530-4802",
            "fax_number": "801-530-0146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 E SOUTH TEMPLE STE 200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021217",
            "telephone_number": "801-530-4802",
            "fax_number": "801-530-0146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE L CONGER D.C., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A",
        "authorized_official_last_name": "CONGER",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICIAN, PRESIDENT",
        "authorized_official_telephone_number": "801-530-4802",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "171096-1202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "534647011005",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4550443",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conger Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Conger Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; 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.