MEDICARE: FREEDOM INTEGRATED MEDICINE 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1447911441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM INTEGRATED MEDICINE LLC

Provider Business Mailing Address
First Line	:	4775 W DAYBREAK PKWY STE 102
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-5139
Country	:	US
Telephone Number	:	801-571-1338
Fax Number	:

Provider Business Practice Location Address
First Line	:	4775 W DAYBREAK PKWY STE 102
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-5139
Country	:	US
Telephone Number	:	801-571-1338
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN CHALK
Credential	:	DC
Telephone Number	:	801-571-1338

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	11/14/2022

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