Provider Demographics
NPI:1639356884
Name:GENERATIONAL HEALTH LLC
Entity Type:Organization
Organization Name:GENERATIONAL HEALTH LLC
Other - Org Name:CHIROPRACTIC HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:FROGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-972-0393
Mailing Address - Street 1:1264 VILLAGE MAIN DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1952
Mailing Address - Country:US
Mailing Address - Phone:801-972-0393
Mailing Address - Fax:801-972-5707
Practice Address - Street 1:1264 VILLAGE MAIN DR UNIT A
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1952
Practice Address - Country:US
Practice Address - Phone:801-972-0393
Practice Address - Fax:801-972-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6790232-1202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center