Provider Demographics
NPI:1760116693
Name:INTUITIVE BALANCE NUTRITION, PLLC
Entity Type:Organization
Organization Name:INTUITIVE BALANCE NUTRITION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHUDNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN, CEDS-S
Authorized Official - Phone:847-721-8030
Mailing Address - Street 1:77 W WASHINGTON ST STE 1620
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3218
Mailing Address - Country:US
Mailing Address - Phone:847-721-8030
Mailing Address - Fax:312-641-6214
Practice Address - Street 1:77 W WASHINGTON ST STE 1620
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3218
Practice Address - Country:US
Practice Address - Phone:847-721-8030
Practice Address - Fax:312-641-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty