NPIMap

Organization Active NPI

Corner Canyon Pain & Medicine

  • General Practice Physician
  • Draper, UT
National Provider Identifier
1992347512
Registry record updated Oct 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CORNER CANYON PAIN & MEDICINE
Practice address
12176 S 1000 E Ste 10
Draper, UT 84020-3221
Phone
(801) 553-9691
Fax
(801) 571-4288
NPI assigned
Oct 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2019

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

Authorized official

Name
Carl Gordon Lesueur, DCNPI 1770715831
Title
Owner
Phone
(801) 553-9691

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

12176 S 1000 E Ste 10
Draper, UT 84020-3221

Mailing address

12176 S 1000 E Ste 10
Draper, UT 84020-3221
Phone (801) 553-9691

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Draper Direct

National Provider Directory

National Provider Directory

Locations

12176 S 1000 E
Ste 10
Draper, UT 84020
Phone (801) 396-8155

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571097600000",
    "number": "1992347512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12176 S 1000 E STE 10",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840203221",
            "telephone_number": "801-553-9691",
            "fax_number": "801-571-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12176 S 1000 E STE 10",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840203221",
            "telephone_number": "801-553-9691",
            "fax_number": "801-571-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNER CANYON PAIN & MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-15",
        "last_updated": "2019-10-15",
        "status": "A",
        "authorized_official_last_name": "LESUEUR",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "GORDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-553-9691",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Draper",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12176 S 1000 E Ste 10",
            "city": "Draper",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840203221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Oct 15, 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.

Verify at the official NPI Registry.