Provider Demographics
NPI:1336322320
Name:BOULDER NUTRITION & EXERCISE SERVICES, LLC
Entity Type:Organization
Organization Name:BOULDER NUTRITION & EXERCISE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:DORAN
Authorized Official - Last Name:FILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:303-440-1015
Mailing Address - Street 1:2900 VALMONT RD STE G
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1344
Mailing Address - Country:US
Mailing Address - Phone:303-440-1015
Mailing Address - Fax:
Practice Address - Street 1:2900 VALMONT RD STE G
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1344
Practice Address - Country:US
Practice Address - Phone:303-440-1015
Practice Address - Fax:303-440-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO925549133V00000X
CO932302133V00000X
CO12905133V00000X
CO972797133V00000X
CO1048357133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1048357OtherCDR
CO12905OtherCDR REGISTRATION
CO932302OtherCDR REGISTRATION
CO925549OtherCDR REGISTRATION
CO972797OtherCDR REGISTRATION