Jeffery Crockett, DC | |
5455 W 11000 N Ste 107, Highland, UT 84003-8801 | |
(801) 770-4333 | |
Not Available |
Full Name | Jeffery Crockett |
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Gender | Male |
Speciality | Chiropractor |
Location | 5455 W 11000 N Ste 107, Highland, Utah |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1912514217 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 11932207-1202 (Utah) | Primary |
Provider Name | Life Health Medical Center Inc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1659731941 PECOS PAC ID: 9436438777 Enrollment ID: O20161109002105 |
Mailing Address | Practice Location Address |
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Jeffery Crockett, DC 1770 E Fort Union Blvd, Cottonwood Heights, UT 84121-2876 Ph: () - | Jeffery Crockett, DC 5455 W 11000 N Ste 107, Highland, UT 84003-8801 Ph: (801) 770-4333 |
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