Provider Demographics
NPI:1033687843
Name:NU-ATRICS: PEDIATRIC NUTRITION & WELLNESS LLC
Entity Type:Organization
Organization Name:NU-ATRICS: PEDIATRIC NUTRITION & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:815-419-8757
Mailing Address - Street 1:211 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:IL
Mailing Address - Zip Code:61739-1172
Mailing Address - Country:US
Mailing Address - Phone:815-419-8757
Mailing Address - Fax:
Practice Address - Street 1:211 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:IL
Practice Address - Zip Code:61739-1172
Practice Address - Country:US
Practice Address - Phone:309-807-3323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition