INTEGRATED FUNCTIONAL MEDICINE (NPI# 1629407697) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629407697 |
| Entity Type | Organization |
| Organization Name | INTEGRATED FUNCTIONAL MEDICINE |
| Practice Address |
458 N 500 W Bountiful UT 84010-6948 |
| Practice Telephone | 8012929355 |
| Practice Fax Number | 8012968050 |
| Mailing Telephone | 8012929355 |
| Mailing Fax Number | 8012968050 |
| Enumeration Date | 2013-11-11 |
| Last Update Date | 2013-11-11 |
| Authorized Official Name | CORY FROGLEY (OWNER) |
| Authorized Official Telephone | 8012929355 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Street Address |
458 N 500 W |
| City | BOUNTIFUL |
| State | UT |
| Zip Code | 84010-6948 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568423564 | Brett Earl | Emergency Medicine | 458 N 500 W, Bountiful, UT 84010-6948 | 2006-03-29 |
| 1124673660 | Jared Thomas Brown | Chiropractor | 458 N 500 W, Bountiful, UT 84010-6948 | 2019-08-01 |
| 1215465042 | Tanner Clark | Chiropractor | 458 N 500 W, Bountiful, UT 84010-6948 | 2017-05-24 |
| 1073061974 | Judd Gines | Chiropractor | 458 N 500 W, Bountiful, UT 84010-6948 | 2016-09-20 |
| 1104296623 | Lauren Lightfield | Nurse Practitioner | 458 N 500 W, Bountiful, UT 84010 | 2015-09-26 |
| 1598005647 | Travis Enrique Castillon | Chiropractor | 458 N 500 W, Bountiful, UT 84010-6948 | 2013-02-27 |
| 1366795502 | Integrated Wellness Group LLC | Chiropractor | 458 N 500 W, Bountiful, UT 84010-6948 | 2012-10-25 |
| 1487935045 | Steven Ivan White | Physician Assistant | 458 N 500 W, Bountiful, UT 84010-6948 | 2011-09-08 |
| 1033168372 | Cory M Frogley | Chiropractor | 458 N 500 W, Bountiful, UT 84010-6948 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225699192 | Jessyca K Willie | Behavior Technician | 415 S. Medical Drive Suite D101, Bountiful, UT 84010 | 2019-06-21 |
| 1336634344 | Shanna Joy Jaggers | Social Worker | 2333 S 200 E, Bountiful, UT 84010 | 2018-06-22 |
| 1447773171 | Live Life Alarms | Emergency Response System Companies | 640 South 500 West, Bountiful, UT 84010 | 2017-07-25 |
| 1902328842 | Hailey Embley | Behavior Technician | 415 Medical Drive D 101, Bountiful, UT 84010 | 2017-07-12 |
| 1508318031 | Beverly Nielsen | Psychologist | 1001 Lakeview Drive, Bountiful, UT 84010 | 2016-11-01 |
| 1295287720 | Samantha Oslund | Speech-Language Pathologist | 415 Medical Dr Ste B102, Bountiful, UT 84010 | 2016-11-01 |
| 1750748273 | Jeremy Clark Morris | Dentist | 59 W 1600 N, Suite 110, Bountiful, UT 84010 | 2016-01-28 |
| 1629464706 | Shane James | Speech-Language Pathologist | 425 Medical Dr Ste 122, Bountiful, UT 84010 | 2015-04-15 |
| 1891186102 | Kenton Francis | Social Worker | 1355 North Main Street #1, Bountiful, UT 84010 | 2015-02-09 |
| 1205233855 | Modern Dental Professionals - Utah, PC | Dentist | 24 S. 500 West, #a, Bountiful, UT 84010 | 2014-11-25 |
| Find all providers in zip 84010 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366056269 | Dry Creek Integrative Medical LLC | General Practice | 3300 N Running Creek Way Bldg E, Lehi, UT 84043-5563 | 2020-09-08 |
| 1225647480 | Utah Therapeutic Health Center | General Practice | 740 E 3900 S Ste 108, Salt Lake City, UT 84107-2525 | 2020-07-23 |
| 1750922415 | Woundtech of Utah, Inc. | General Practice | 517 D St, Salt Lake City, UT 84103-2831 | 2019-10-03 |
| 1992355630 | East West Health Pleasant Grove LLC | General Practice | 11020 N 5500 W # 101, Highland, UT 84003-9643 | 2019-09-15 |
| 1396393369 | Root Medical | General Practice | 266 W 100 N Ste 2, Vernal, UT 84078-2026 | 2019-09-03 |
| 1154973576 | Koraima Morel Tirado | General Practice | 1035 W 190 S, Lehi, UT 84043-3833 | 2019-07-15 |
| 1841856986 | Northwestern Band of The Shoshone Nation Health & Human Services Dept. | General Practice | 241 W Forest St Ste A, Brigham City, UT 84302-2014 | 2019-05-14 |
| 1790297661 | The Bridge Recovery Center | General Practice | 98 N 6680 W, Hurricane, UT 84737-6138 | 2017-10-31 |
| 1790295947 | Low T Clinic, LLC | General Practice | 2150 N Main St Ste 10, North Logan, UT 84341-1740 | 2017-10-02 |
| 1104345636 | Coral Canyon Joint & Spine Health | General Practice | 83 S 2600 W Ste 102, Hurricane, UT 84737-3268 | 2017-09-15 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on INTEGRATED FUNCTIONAL MEDICINE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.