Provider Demographics
NPI:1053583880
Name:BABCOCK WELLNESS
Entity type:Organization
Organization Name:BABCOCK WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-565-1411
Mailing Address - Street 1:9265-A S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088
Mailing Address - Country:US
Mailing Address - Phone:810-565-1411
Mailing Address - Fax:801-565-1411
Practice Address - Street 1:9265-A S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088
Practice Address - Country:US
Practice Address - Phone:810-565-1411
Practice Address - Fax:801-565-1411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BABCOCK WELLNESS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51894851202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty