Provider Demographics
NPI:1013971381
Name:FOOD PHYSICS & BODY DYNAMICS LLC
Entity Type:Organization
Organization Name:FOOD PHYSICS & BODY DYNAMICS LLC
Other - Org Name:THE SPIRIT OF FOOD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM, DIPLAC, LAC
Authorized Official - Phone:910-777-7307
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:CASTLE HAYNE
Mailing Address - State:NC
Mailing Address - Zip Code:28429-0056
Mailing Address - Country:US
Mailing Address - Phone:910-777-7307
Mailing Address - Fax:
Practice Address - Street 1:2826 BELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:CASTLE HAYNE
Practice Address - State:NC
Practice Address - Zip Code:28429-6506
Practice Address - Country:US
Practice Address - Phone:910-777-7307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02298133NN1002X, 171100000X, 261QR1100X
174H00000X, 2083P0901X, 208VP0014X, 246Y00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Multi-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearchGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
016303OtherNATL CERTIFICATION NCCAOM
1225108400OtherNPI-OWNER ASSIGNED L DAWSON
29-1291OtherSTANDARD OF OCCUPATION CODE-ACUPUNCTURIST