Provider Demographics
NPI:1679706261
Name:EAGLE APPLIED SCIENCES, LLC
Entity Type:Organization
Organization Name:EAGLE APPLIED SCIENCES, LLC
Other - Org Name:INTEGRATIVE WELLNESS AND RESEARCH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BANTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH
Authorized Official - Phone:210-477-9242
Mailing Address - Street 1:200 CONCORD PLAZA DR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6943
Mailing Address - Country:US
Mailing Address - Phone:210-477-9242
Mailing Address - Fax:210-581-8609
Practice Address - Street 1:225 E SONTERRA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3992
Practice Address - Country:US
Practice Address - Phone:210-477-2799
Practice Address - Fax:210-490-0017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE APPLIED SCIENCES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty