Healthcare Provider Details

I. General information

NPI: 1396682258
Provider Name (Legal Business Name): INTEGRATED FUNCTIONAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 S HOLLADAY BLVD STE 202
SALT LAKE CITY UT
84117-7168
US

IV. Provider business mailing address

458 N 500 W
BOUNTIFUL UT
84010-6948
US

V. Phone/Fax

Practice location:
  • Phone: 385-800-5015
  • Fax: 801-277-6678
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT FROGLEY
Title or Position: OWNER
Credential: DC
Phone: 801-816-0332