Provider Demographics
NPI:1982852067
Name:PROACTION HEALTH, LLC
Entity Type:Organization
Organization Name:PROACTION HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/REGISTERED DIETITIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:314-960-2696
Mailing Address - Street 1:3232 VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-3420
Mailing Address - Country:US
Mailing Address - Phone:314-960-2696
Mailing Address - Fax:636-937-2086
Practice Address - Street 1:3232 VICTORIA RD
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-3420
Practice Address - Country:US
Practice Address - Phone:314-960-2696
Practice Address - Fax:636-937-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty