Provider Demographics
NPI:1215595871
Name:LIFE HEALTH REGENERATION LLC
Entity Type:Organization
Organization Name:LIFE HEALTH REGENERATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-450-6940
Mailing Address - Street 1:1770 E FORT UNION BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2881
Mailing Address - Country:US
Mailing Address - Phone:801-997-8881
Mailing Address - Fax:801-944-5910
Practice Address - Street 1:1770 E FORT UNION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2881
Practice Address - Country:US
Practice Address - Phone:801-997-8881
Practice Address - Fax:801-944-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty