Provider Demographics
NPI:1730461096
Name:NUTRITION AND CANCER CONNECTION, LLC
Entity Type:Organization
Organization Name:NUTRITION AND CANCER CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:970-481-6463
Mailing Address - Street 1:802 STOVER ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3417
Mailing Address - Country:US
Mailing Address - Phone:970-481-6463
Mailing Address - Fax:
Practice Address - Street 1:802 STOVER ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3417
Practice Address - Country:US
Practice Address - Phone:970-481-6463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty