Healthcare Provider Details

I. General information

NPI: 1285382648
Provider Name (Legal Business Name): HIGH LIFE INTEGRATIVE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 S HIGHLAND DR STE 202
SALT LAKE CITY UT
84124-2786
US

IV. Provider business mailing address

4190 S HIGHLAND DR STE 202
SALT LAKE CITY UT
84124-2786
US

V. Phone/Fax

Practice location:
  • Phone: 801-332-9877
  • Fax: 888-331-1646
Mailing address:
  • Phone: 801-332-9877
  • Fax: 888-331-1646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER EICHNER
Title or Position: OWNER
Credential: NP
Phone: 801-332-9877