Provider Demographics
NPI:1720691280
Name:BRIGHTSIDE NUTRITION COUNSELING
Entity Type:Organization
Organization Name:BRIGHTSIDE NUTRITION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:806-523-9265
Mailing Address - Street 1:1 E ERIE ST STE 525
Mailing Address - Street 2:#227
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2980
Mailing Address - Country:US
Mailing Address - Phone:224-357-6599
Mailing Address - Fax:
Practice Address - Street 1:1 E ERIE ST STE 525
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2980
Practice Address - Country:US
Practice Address - Phone:224-357-6599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty