MEDICARE: GENERATIONAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	6790232-1202	UT

General Provider Information

NPI Number	:	1639356884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1264 VILLAGE MAIN DR UNIT A
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-1952
Country	:	US
Telephone Number	:	801-972-0393
Fax Number	:	801-972-5707

Provider Business Practice Location Address
First Line	:	1264 VILLAGE MAIN DR UNIT A
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-1952
Country	:	US
Telephone Number	:	801-972-0393
Fax Number	:	801-972-5707

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL R FROGLEY
Credential	:	D.C.
Telephone Number	:	801-972-0393

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	02/18/2008

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