Provider Demographics
NPI:1922787787
Name:ONWARD PERFORMANCE NUTRITION LLC
Entity Type:Organization
Organization Name:ONWARD PERFORMANCE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOMSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:318-402-9597
Mailing Address - Street 1:3532 N BOSWORTH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8745
Mailing Address - Country:US
Mailing Address - Phone:318-402-9597
Mailing Address - Fax:
Practice Address - Street 1:3532 N BOSWORTH AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8745
Practice Address - Country:US
Practice Address - Phone:318-402-9597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty