Active NPI
Lillian Nicole Fackrell, DC
- Chiropractor
- Midvale, UT
National Provider Identifier
1801652367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 13763325-1202
- Practice address
- 6717 S 900 E Ste 101
Midvale, UT 84047-5755 - Phone
- (801) 784-8886
- NPI assigned
- Feb 22, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 13763325 | UT | |
| Chiropractor | 111N00000X | 13763325-1202 | UT | Primary |
Addresses
Primary practice location
6717 S 900 E Ste 101
Midvale, UT 84047-5755
Mailing address
190 S Tamarak Cir
Lehi, UT 84043-2761
Phone (816) 419-6513
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 |
|---|---|---|---|
| 13763325 | UT | MD | Chiropractor |
| 13763325-1202 | UT | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724716800000",
"number": "1801652367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 S TAMARAK CIR",
"city": "LEHI",
"state": "UT",
"postal_code": "840432761",
"telephone_number": "816-419-6513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6717 S 900 E STE 101",
"city": "MIDVALE",
"state": "UT",
"postal_code": "840475755",
"telephone_number": "801-784-8886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FACKRELL",
"first_name": "LILLIAN",
"middle_name": "NICOLE",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-22",
"last_updated": "2024-08-27",
"certification_date": "2024-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "UT",
"license": "13763325",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "UT",
"license": "13763325-1202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midvale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.