Active NPI
Gannon O Ward, DC
- Chiropractor
- Draper, UT
National Provider Identifier
1922567791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 11172962-1202
- Practice address
- 392 E 12300 S Ste C
Draper, UT 84020-8043 - Phone
- (801) 849-1029
- Fax
- (801) 890-0513
- NPI assigned
- Mar 19, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 11172962-1202 | UT | Primary |
Addresses
Primary practice location
392 E 12300 S Ste C
Draper, UT 84020-8043
Mailing address
392 E 12300 S Ste C
Draper, UT 84020-8043
Phone (801) 849-1029
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11172962-1202 | Other | UT | UTAH CHIROPRACTIC LICENSE NUMBER |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11172962-1202 | UT | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1922567791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "392 E 12300 S STE C",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208043",
"telephone_number": "801-849-1029",
"fax_number": "801-890-0513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "392 E 12300 S STE C",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208043",
"telephone_number": "801-849-1029",
"fax_number": "801-890-0513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARD",
"first_name": "GANNON",
"middle_name": "O",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-03-19",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "UT",
"license": "11172962-1202",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UTAH CHIROPRACTIC LICENSE NUMBER",
"identifier": "11172962-1202",
"state": "UT"
}
],
"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 Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.