Provider Demographics
NPI:1982577805
Name:LIVE LIMITLESS NUTRITION LLC
Entity type:Organization
Organization Name:LIVE LIMITLESS NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:317-364-2202
Mailing Address - Street 1:2800 N MILWAUKEE AVE APT 504
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7984
Mailing Address - Country:US
Mailing Address - Phone:317-364-2202
Mailing Address - Fax:
Practice Address - Street 1:2800 N MILWAUKEE AVE APT 504
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7984
Practice Address - Country:US
Practice Address - Phone:317-364-2202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty