Provider Demographics
NPI:1689340887
Name:BACK IN BALANCE NUTRITION LLC
Entity Type:Organization
Organization Name:BACK IN BALANCE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:865-748-8036
Mailing Address - Street 1:960 STARKEY RD UNIT 7206
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2488
Mailing Address - Country:US
Mailing Address - Phone:865-748-8036
Mailing Address - Fax:
Practice Address - Street 1:12519 108TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2715
Practice Address - Country:US
Practice Address - Phone:865-748-8036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty