Provider Demographics
NPI:1699115188
Name:LIFE SPRING PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:LIFE SPRING PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:OBAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-786-9030
Mailing Address - Street 1:275 W 200 N
Mailing Address - Street 2:STE 7
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1861
Mailing Address - Country:US
Mailing Address - Phone:801-546-1300
Mailing Address - Fax:
Practice Address - Street 1:275 W 200 N
Practice Address - Street 2:STE 7
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1861
Practice Address - Country:US
Practice Address - Phone:801-546-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5867369-1205261QH0100X
UT5867389-1205261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service