Healthcare Provider Details

I. General information

NPI: 1871322578
Provider Name (Legal Business Name): BALANCED BITES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 SHAWNEE VIEW CT
EUREKA MO
63025-4018
US

IV. Provider business mailing address

5320 SHAWNEE VIEW CT
EUREKA MO
63025-4018
US

V. Phone/Fax

Practice location:
  • Phone: 816-679-2491
  • Fax:
Mailing address:
  • Phone: 816-679-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE R ADAMS
Title or Position: REGISTERED DIETITIAN
Credential: MS, RD, CSR, LD
Phone: 816-679-2491