Cache Valley Chiropractic Clinic LLC

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

169476-1202 Issued in UT

Legal business name

CACHE VALLEY CHIROPRACTIC CLINIC LLC

Practice address

169 N Gateway Dr Ste 223
Providence, UT 84332-9856

Phone

(435) 752-2772

Fax

(435) 752-2878

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Neil Louis Erickson, DC

Title

Owner

Phone

(435) 752-2772

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1902943863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 N GATEWAY DR STE 223",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329856",
            "telephone_number": "435-752-7722",
            "fax_number": "435-752-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 N GATEWAY DR STE 223",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329856",
            "telephone_number": "435-752-2772",
            "fax_number": "435-752-2878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "755 S Main St",
            "address_2": "Suite #100",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843215402",
            "country_code": "US",
            "telephone_number": "435-752-2772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CACHE VALLEY CHIROPRACTIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-752-2772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "UT",
            "license": "169476-1202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "22321",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "10294",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "519720002009",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "94287113577001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMIA",
            "identifier": "870395551ER1",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Lavan Bundy, PT, DPT
• Natalie Burningham, MT-BC, IBDS
• Matthew Burraston, RBT
• Todd Michael Butler, DMD
• Cache Valley Assisted Living
• Cache Valley Vein
• Aaron Cannon
• Joseph Carley, DPT
• Vera B Carlson, MD, PHD
• Amanda Castillo, CSW

• Orthopedic Chiropractor in Providence, UT
• Providers in Providence, UT by specialty
• Orthopedic Chiropractor in Utah

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.