Provider Demographics
NPI:1770191694
Name:ELEVATE FUNCTIONAL HEALTH, LLC
Entity Type:Organization
Organization Name:ELEVATE FUNCTIONAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:COMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-669-3952
Mailing Address - Street 1:667 SWEETSPRING DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5469
Mailing Address - Country:US
Mailing Address - Phone:435-668-7284
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S STE 103
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5731
Practice Address - Country:US
Practice Address - Phone:435-668-7284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty