Active NPI
Nathan Randall Wall, D.C.
- Pediatric Chiropractor
- Draper, UT
National Provider Identifier
1578810123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Chiropractor
- License
- 6145802-1202
- Practice address
- 12197 S Draper Gate Dr
Draper, UT 84020-8078 - Phone
- (801) 590-0600
- Fax
- (801) 590-0643
- NPI assigned
- Aug 13, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Chiropractor | 111NP0017X | 6145802-1202 | UT | Primary |
Addresses
Primary practice location
12197 S Draper Gate Dr
Draper, UT 84020-8078
Mailing address
12197 S. Draper Gate Dr.
Ste. 108
Silverdale, UT 98383-8301
Phone (801) 590-0600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6145802-1202 | UT | MD | Pediatric Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522800000000",
"number": "1578810123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12197 S. DRAPER GATE DR.",
"address_2": "STE. 108",
"city": "SILVERDALE",
"state": "UT",
"postal_code": "983838301",
"telephone_number": "801-590-0600",
"fax_number": "801-590-0643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12197 S DRAPER GATE DR",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208078",
"telephone_number": "801-590-0600",
"fax_number": "801-590-0643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "NATHAN",
"middle_name": "RANDALL",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-13",
"last_updated": "2018-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "111NP0017X",
"taxonomy_group": "",
"desc": "Chiropractor, Pediatric Chiropractor",
"state": "UT",
"license": "6145802-1202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.