Provider Demographics
NPI:1053641555
Name:6WEEKWORKOUT LLC
Entity Type:Organization
Organization Name:6WEEKWORKOUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIK
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:BANNISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-790-9481
Mailing Address - Street 1:3691 S CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5567
Mailing Address - Country:US
Mailing Address - Phone:775-790-9679
Mailing Address - Fax:775-883-6840
Practice Address - Street 1:3691 S CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5567
Practice Address - Country:US
Practice Address - Phone:775-790-9679
Practice Address - Fax:775-883-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0900026381302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization