Stucky Chiropractic PC
Organization Active NPI Chiropractor · Hyrum, UT
NPI 1891044889 · NPPES record last updated Sep 6, 2012
Key facts
- NPI
- 1891044889
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2857381202 (UT)
- Legal business name
- STUCKY CHIROPRACTIC PC
- Practice address
- 130 N 800 E
Hyrum, UT 84319-1150 - Phone
- (435) 245-3500
- Fax
- (435) 245-3500
- NPI assigned
- Sep 5, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Jon L. Stucky, DC
- Title
- Pres.
- Phone
- (435) 245-3500
Practitioners 2
-
Jon L. Stucky, DC
-
Cade Jex Stucky, BS, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121003000559 | UT | Part B Supplier - Clinic/Group Practice | 7214186410 |
Receives reassigned benefits from 1 practitioner Practice locations: Hyrum, UT |
National Provider Directory
Locations
130 N 800 E
Hyrum, UT 84319
Phone (435) 245-3500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2857381202 | UT | Yes |
Addresses
Primary practice location
130 N 800 E
Hyrum, UT 84319-1150
Mailing address
130 N 800 E
Hyrum, UT 84319-1150
Phone (435) 245-3500
Other providers in Hyrum, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.