| Organization Name: | SPINE AND MUSCULAR REHABILITATION CHIROPRACTIC PLLC |
| NPI Number: | 1073805289 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRENTON STEVENS (OWNER) |
| Mailing Address: | 1634 N Main St North Logan |
| State: | UT US |
| Postal Code: | 843411920 |
| Phone Number: | 2083518329 |
| Fax Number: | |
| NPI Enumeration Date: | 05/05/2011 |
| NPI Last Update Date: | 05/05/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 7975292-1202 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |