Provider Demographics
NPI:1568168102
Name:INTEGRATED FUNCTIONAL MEDICINE, LLC
Entity Type:Organization
Organization Name:INTEGRATED FUNCTIONAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:WERSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-292-9355
Mailing Address - Street 1:10376 S JORDAN GTWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3954
Mailing Address - Country:US
Mailing Address - Phone:801-816-0332
Mailing Address - Fax:801-816-0331
Practice Address - Street 1:10376 S JORDAN GTWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3954
Practice Address - Country:US
Practice Address - Phone:801-816-0332
Practice Address - Fax:801-816-0331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED FUNCTIONAL MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty