Provider Demographics
NPI:1699228056
Name:RIGHT BALANCE INTEGRATIVE NUTRITION
Entity Type:Organization
Organization Name:RIGHT BALANCE INTEGRATIVE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RD, LDN
Authorized Official - Phone:484-467-8506
Mailing Address - Street 1:18 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3240
Mailing Address - Country:US
Mailing Address - Phone:484-423-3400
Mailing Address - Fax:
Practice Address - Street 1:18 CAMPUS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3240
Practice Address - Country:US
Practice Address - Phone:484-423-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty