NPIMap

Organization Active NPI

Integrated Wellness South Jordan PLLC

  • Chiropractor
  • South Jordan, UT
National Provider Identifier
1679874523
Registry record updated May 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
263628-1202 Issued in UT
Legal business name
INTEGRATED WELLNESS SOUTH JORDAN PLLC
Practice address
10684 River Front Pkwy
South Jordan, UT 84095-3525
Phone
(801) 816-0332
Fax
(801) 816-0331
NPI assigned
Nov 9, 2010
Last updated
May 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2013

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

Authorized official

Name
Dr. Randy Woodward, D.C.
Title
Owner
Phone
(801) 816-0332

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 263628-1202 UT Primary

Addresses

Primary practice location

10684 River Front Pkwy
South Jordan, UT 84095-3525

Mailing address

10684 River Front Pkwy
South Jordan, UT 84095-3525
Phone (801) 816-0332

National Provider Directory

National Provider Directory

Locations

10684 S River Front Pkwy
South Jordan, UT 84095
Phone (801) 816-0332

Practitioners & affiliated clinicians

Practitioners 1

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": "1289260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1679874523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10684 RIVER FRONT PKWY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840953525",
            "telephone_number": "801-816-0332",
            "fax_number": "801-816-0331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10684 RIVER FRONT PKWY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840953525",
            "telephone_number": "801-816-0332",
            "fax_number": "801-816-0331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED WELLNESS SOUTH JORDAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-09",
        "last_updated": "2013-05-15",
        "status": "A",
        "authorized_official_last_name": "WOODWARD",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-816-0332",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "263628-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; 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.