| Organization Name: | SPORTS CHIROPRACTIC AND WELLNESS CENTER PC |
| NPI Number: | 1356643001 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRUCE C NIELSON (OWNER) |
| Mailing Address: | 193 E Fort Union Blvd 203 Midvale |
| State: | UT US |
| Postal Code: | 840475660 |
| Phone Number: | 8015681598 |
| Fax Number: | 8015681594 |
| NPI Enumeration Date: | 12/01/2010 |
| NPI Last Update Date: | 06/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | 365045-1202 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | 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. |