Provider Demographics
NPI:1174037113
Name:HEALTHY FUNCTION LLC
Entity Type:Organization
Organization Name:HEALTHY FUNCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, OMT
Authorized Official - Phone:208-521-3257
Mailing Address - Street 1:4270 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4788
Mailing Address - Country:US
Mailing Address - Phone:208-521-3257
Mailing Address - Fax:
Practice Address - Street 1:550 W SUNNYSIDE RD STE 7
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4642
Practice Address - Country:US
Practice Address - Phone:208-521-3257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDH-0982124Q00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty