Provider Demographics
NPI:1124368964
Name:HOLISTIC ROOTS NUTRITION
Entity Type:Organization
Organization Name:HOLISTIC ROOTS NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOSICK
Authorized Official - Suffix:
Authorized Official - Credentials:MNT
Authorized Official - Phone:303-818-0494
Mailing Address - Street 1:964 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4052
Mailing Address - Country:US
Mailing Address - Phone:303-818-0494
Mailing Address - Fax:
Practice Address - Street 1:964 MADISON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4052
Practice Address - Country:US
Practice Address - Phone:303-818-0494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty