Healthcare Provider Details

I. General information

NPI: 1609559384
Provider Name (Legal Business Name): BALANCED NUTRITION THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CRESTWOOD EXECUTIVE CTR STE 500
SAINT LOUIS MO
63126-1948
US

IV. Provider business mailing address

529 VISTA HILLS CT
EUREKA MO
63025-3605
US

V. Phone/Fax

Practice location:
  • Phone: 636-686-0682
  • Fax:
Mailing address:
  • Phone:
  • 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: REBECCA ADAMS
Title or Position: DIETITIAN
Credential: RD
Phone: 636-686-0682