Provider Demographics
NPI:1780451864
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:801-296-8060
Mailing Address - Street 1:151 E 5600 S STE 104
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8140
Mailing Address - Country:US
Mailing Address - Phone:385-228-4758
Mailing Address - Fax:
Practice Address - Street 1:151 E 5600 S STE 104
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-8140
Practice Address - Country:US
Practice Address - Phone:385-228-4758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED FUNCTIONAL MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty