Healthcare Provider Details

I. General information

NPI: 1366795502
Provider Name (Legal Business Name): INTEGRATED WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 N 500 W
BOUNTIFUL UT
84010-6948
US

IV. Provider business mailing address

458 N 500 W
BOUNTIFUL UT
84010-6948
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-9355
  • Fax: 801-296-8050
Mailing address:
  • Phone: 801-292-9355
  • Fax: 801-296-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CORY FROGLEY
Title or Position: OWNER
Credential: DC
Phone: 801-292-9355