Provider Demographics
NPI:1093001919
Name:NUTRITION UNLIMITED
Entity Type:Organization
Organization Name:NUTRITION UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELIGON-KETCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:215-514-6658
Mailing Address - Street 1:1424 KENILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2208
Mailing Address - Country:US
Mailing Address - Phone:215-514-6658
Mailing Address - Fax:267-455-0825
Practice Address - Street 1:1301 WHITEHORSE MERCERVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3826
Practice Address - Country:US
Practice Address - Phone:215-514-6658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN093937133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty