Provider Demographics
NPI:1780297614
Name:BACK ON TRACK NUTRITION LLC
Entity type:Organization
Organization Name:BACK ON TRACK NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATY
Authorized Official - Middle Name:CHRISTINN
Authorized Official - Last Name:STEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MDA, RDN
Authorized Official - Phone:928-368-3645
Mailing Address - Street 1:15018 N SANTIAGO PL
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-1625
Mailing Address - Country:US
Mailing Address - Phone:928-368-3645
Mailing Address - Fax:
Practice Address - Street 1:6625 S RURAL RD STE 111
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3717
Practice Address - Country:US
Practice Address - Phone:480-253-9547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty