| Lifetime Family Wellness | |
|
5319 Adams Ave Pkwy, Ste D, Ogden, UT 84405-4773 | |
| (801) 479-3200 | |
| Not Available |
| Full Name | Lifetime Family Wellness |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 5319 Adams Ave Pkwy, Ogden, Utah |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639590961 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 7564602-1202 (Utah) | Primary |
| Provider Name | Gerald Burkely Larsen |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1821314824 PECOS PAC ID: 5294865820 Enrollment ID: I20100609000052 |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Family Wellness Po Box 9641, Ogden, UT 84409-0641 Ph: (801) 479-3200 | Lifetime Family Wellness 5319 Adams Ave Pkwy, Ste D, Ogden, UT 84405-4773 Ph: (801) 479-3200 |
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