| Organization Name: | INNOVATION PAIN MANAGEMENT, LLC |
| NPI Number: | 1073807939 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NATHAN DEE MILLER (MANAGING MEMBER) |
| Mailing Address: | 1988 W 930 N Suite B Pleasant Grove |
| State: | UT US |
| Postal Code: | 840624131 |
| Phone Number: | 8018992053 |
| Fax Number: | 8014927615 |
| NPI Enumeration Date: | 06/07/2011 |
| NPI Last Update Date: | 09/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |