Healthcare Provider Details

I. General information

NPI: 1033687843
Provider Name (Legal Business Name): NU-ATRICS: PEDIATRIC NUTRITION & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W WILLOW ST
FAIRBURY IL
61739-1172
US

IV. Provider business mailing address

211 W WILLOW ST
FAIRBURY IL
61739-1172
US

V. Phone/Fax

Practice location:
  • Phone: 309-807-3323
  • Fax:
Mailing address:
  • Phone: 815-419-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ADRIAN L. BACHMAN
Title or Position: PRESIDENT
Credential: DC, MS
Phone: 815-419-8757