Provider Demographics
NPI:1043435233
Name:UPZEN HEALTH, INC.
Entity Type:Organization
Organization Name:UPZEN HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-572-2272
Mailing Address - Street 1:9055 S 255 W
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2654
Mailing Address - Country:US
Mailing Address - Phone:801-572-2272
Mailing Address - Fax:
Practice Address - Street 1:9055 S 255 W
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2654
Practice Address - Country:US
Practice Address - Phone:801-572-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5555973-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870395551005Medicaid