SOUTH JORDAN HEALTH AND WELLNESS (NPI# 1700135233) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700135233 |
| Entity Type | Organization |
| Organization Name | SOUTH JORDAN HEALTH AND WELLNESS |
| Practice Address |
272 N Broadway St #11 Tooele UT 84074-2244 |
| Practice Telephone | 4358821621 |
| Practice Fax Number | 4358828267 |
| Mailing Telephone | 4358821621 |
| Mailing Fax Number | 4358828267 |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2016-06-27 |
| Authorized Official Name | DR. MATTHEW PETERSON (PRESIDENT) |
| Authorized Official Telephone | 4358821621 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 370378-1202 | UT | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | STATE LICENSE | 3703781202 | 01 |
| Street Address |
272 N BROADWAY ST #11 |
| City | TOOELE |
| State | UT |
| Zip Code | 84074-2244 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134379027 | Jeramy Rawn Jenkins | Audiologist | 272 N Broadway St, Tooele, UT 84074-2244 | 2008-09-26 |
| 1982214680 | Jenifer Richards Todd | Behavior Technician | 272 N Broadway St, Tooele, UT 84074-2244 | 2020-08-06 |
| 1417565052 | Carin Renee James | Behavior Technician | 272 N Broadway St, Tooele, UT 84074-2244 | 2020-07-20 |
| 1326663899 | Hannah Noel Melton | Behavior Technician | 272 N Broadway St, Tooele, UT 84074-2244 | 2020-06-10 |
| 1396389409 | Martha T Hansen | Behavior Technician | 272 N Broadway St, Tooele, UT 84074-2244 | 2019-10-31 |
| 1821563040 | Deanna Michelle Parish | Behavior Technician | 272 N Broadway St, Tooele, UT 84074-2244 | 2018-10-04 |
| 1114413994 | Darian Paige Scott | Behavior Technician | 272 N Broadway St, Tooele, UT 84074-2244 | 2018-07-05 |
| 1114371523 | Lea Durfey | Massage Therapist | 272 N Broadway St, Tooele, UT 84074-2244 | 2016-04-21 |
| 1841434982 | Listening Essentials, LLC | Clinic/Center | 272 N Broadway St, Tooele, UT 84074-2244 | 2009-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689233397 | Leah Elizabeth Harper I | Behavior Technician | 39 Millpond Stansbury Park, Tooele, UT 84074 | 2019-06-07 |
| 1245710789 | Tanna Marie Shelley | Community Health Worker | 27 So Main St, Tooele, UT 84074 | 2018-08-15 |
| 1528548062 | Barbara T Cederlof | Community Health Worker | 27 South Main St., Tooele, UT 84074 | 2018-08-15 |
| 1235615600 | Ashley Christine Wilson | Case Manager/Care Coordinator | 27 South Main, Tooele, UT 84074 | 2018-07-18 |
| 1174016976 | Makenzie Green | Case Manager/Care Coordinator | 27 S Main, Tooele, UT 84074 | 2018-06-07 |
| 1386151835 | Monica Lee | Physical Therapist | 6727 Ut-36 #300, Stansbury Park, UT 84074 | 2018-01-05 |
| 1871976183 | Pagnani Physical Therapy | Physical Therapist | 6727 North State Hwy 36, Suite 300, Stansbury Park, UT 84074 | 2015-07-06 |
| 1407248222 | Pebble Creek Counseling Center | Counselor | 494 E 2400 N Ste B, Tooele, UT 84074 | 2015-03-03 |
| 1528496221 | Emily Carlson | Case Manager/Care Coordinator | 220 North Millpond Rd, Suite 100, Stansbury Park, UT 84074 | 2013-10-16 |
| 1710327218 | Angela Michelle Demoss | Nurse Practitioner | 682 Country Club, Stansbury Park, UT 84074 | 2013-06-28 |
| Find all providers in zip 84074 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760826184 | Headache Relief Specialists LLC | Chiropractor | 1244 No Main, Suite 100, Tooele, UT 84074 | 2013-04-29 |
| 1861534356 | Tooele Valley Spine Center | Chiropractor | 1244 N Main St Ste 100, Tooele, UT 84074-9839 | 2007-02-13 |
| 1942368345 | Devron L. Brown | Chiropractor | 352 N Main St, Tooele, UT 84074-1657 | 2006-12-05 |
| 1407830953 | Glenn Hunter Thompson | Chiropractor | 1244 N Main St, Suite100, Tooele, UT 84074-9838 | 2005-11-29 |
| 1811413909 | Marty Leroy Rueckert | Chiropractor | 250 N Main St, Tooele, UT 84074-1650 | 2017-08-21 |
| 1598995763 | John Todd Mcphie | Chiropractor | 1244 N Main St, Ste 100, Tooele, UT 84074-9839 | 2009-07-21 |
| 1669636817 | Health Source of Tooele Inc | Chiropractor | 352 N Main St, Tooele, UT 84074-1657 | 2008-07-17 |
| 1699953752 | Tooele Family Chiropractic, Inc. | Chiropractor | 134 W 1180 N, Suite #5, Tooele, UT 84074-1483 | 2008-01-31 |
| 1982894499 | Thomas Cole Snyder | Chiropractor | 300 S Main St, Suite Number 2, Tooele, UT 84074-2746 | 2007-07-31 |
| 1770691370 | Kip C Porter | Chiropractor | 275 S Main St, Tooele, UT 84074-2743 | 2006-08-25 |
| Find all providers in TOOELE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.