Provider Demographics
NPI:1902417058
Name:ON THE MOVE NUTRITION
Entity Type:Organization
Organization Name:ON THE MOVE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JURCAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MPH, RD, LD
Authorized Official - Phone:440-865-1266
Mailing Address - Street 1:14837 DETROIT AVE STE 189
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3909
Mailing Address - Country:US
Mailing Address - Phone:440-865-1266
Mailing Address - Fax:
Practice Address - Street 1:9712 BALTIC RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1719
Practice Address - Country:US
Practice Address - Phone:440-865-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467929125OtherINDIVIDUAL NPI
OHLD.08277OtherLICENSURE