ROOTS AND RAICES FUNCTIONAL MEDICINE INC. (NPI# 1952955296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952955296 |
| Entity Type | Organization |
| Organization Name | ROOTS AND RAICES FUNCTIONAL MEDICINE INC. |
| Other Organization Name | ROOTS AND RAICES FUNCTIONAL MEDICINE |
| Practice Address |
1452 E Ridgeline Dr Ste 5 South Ogden UT 84405-4949 |
| Mailing Address |
1452 E Ridgeline Dr Ste 5 Ogden UT 84405-4949 |
| Practice Telephone | 4352677668 |
| Practice Fax Number | 3852984027 |
| Mailing Telephone | 4359197668 |
| Mailing Fax Number | 8016893985 |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2020-01-02 |
| Authorized Official Name | SUSAN M NAYLOR (PRESIDENT) |
| Authorized Official Telephone | 4352677668 |
| Authorized Official Credential | FNP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Roots and Raices Functional Medicine | Other Name - Individual/Organization |
| Street Address |
1452 E RIDGELINE DR STE 5 |
| City | SOUTH OGDEN |
| State | UT |
| Zip Code | 84405-4949 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669028171 | Alyssa House | Behavioral Analyst | 4933 1500 West #110, Riverdale, UT 84405 | 2019-08-12 |
| 1518525989 | Petersen Farms Assisted Living & Memory Care | Assisted Living Facility | 6980 S. 475 E., South Weber, UT 84405 | 2019-05-31 |
| 1376038141 | National Vision, Inc. | Technician/Technologist | 821 West Riverdale Road, Riverdale, UT 84405 | 2018-06-25 |
| 1194218461 | South Weber City | Ambulance | 7365 S 1375 E, South Weber, UT 84405 | 2018-06-12 |
| 1528572682 | Sandra Jo Scott | Dental Hygienist | 264 W Ridgeline Dr, Washington Terrace, UT 84405 | 2017-11-28 |
| 1376079061 | Loretta Shupe | Registered Nurse | 5319 S 500 E, Ogden, UT 84405 | 2017-05-02 |
| 1134661374 | Randy Ferrin | Registered Nurse | 5697 Maplewood Drive, South Ogden, UT 84405 | 2016-11-04 |
| 1871046284 | Karla Rosen | Counselor | 5202 S. Freeway Park Dr., Riverdale, UT 84405 | 2016-08-02 |
| 1053784520 | Jenifer Rebecca Nilson Smith | Physical Therapist | 5648 S. Adams Ave, Washington Terrace, UT 84405 | 2015-11-05 |
| 1972976454 | Jenniferlyn Fletcher | Physical Therapy Assistant | 5648 South Adams Ave, Washington Terrace, UT 84405 | 2015-11-05 |
| Find all providers in zip 84405 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447485123 | Daniel J. Hansen, D.o., Pllc | Clinic/Center | 1495 E Ridgeline Dr, South Ogden, UT 84405-4976 | 2009-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376166405 | Be Well Connected, Pllc | Clinic/Center | 13965 N Willow Creek Dr, Beaverdam, UT 84306-8707 | 2020-05-23 |
| 1306466636 | Mountain Moments | Clinic/Center | 1154 Center Dr Ste D250, Park City, UT 84098-1258 | 2020-04-16 |
| 1639718091 | Anchor Spinal Rehab - Orem | Clinic/Center | 865 N 900 W, Orem, UT 84057-7701 | 2020-01-03 |
| 1124685508 | Comprehensive Chiropractic and Recovery | Clinic/Center | 1684 W Reunion Ave Ste 100, South Jordan, UT 84095-4609 | 2019-05-21 |
| 1770050684 | Bedrock Health Center, Pllc | Clinic/Center | 347 N 300 W Ste 203, Kaysville, UT 84037-1828 | 2018-10-29 |
| 1992170443 | Usu Student Health & Wellness | Clinic/Center | 9100 Old Main Hl, Logan, UT 84322-9100 | 2015-12-09 |
| 1548630908 | Smart Medical, LLC | Clinic/Center | 6337 S Highland Dr, Ste 110, Salt Lake City, UT 84121-2107 | 2015-09-29 |
| 1639557846 | Flow Acupuncture & Apothecary | Clinic/Center | 1390 S 1100 E Ste 110, Salt Lake City, UT 84105-2463 | 2015-05-08 |
| 1073805289 | Spine and Muscular Rehabilitation Chiropractic Pllc | Clinic/Center | 1634 N Main St, North Logan, UT 84341-1920 | 2011-05-05 |
| 1447400114 | High Five Chiropractic | Clinic/Center | 456 State Road 198, Salem, UT 84653-9187 | 2008-09-30 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH OGDEN |
| Zip Code | 84405 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.