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General NPI Number Information
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NPI Number | 1093662645
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Entity Type | Organization
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Legal Business Name | BACK2BASICS FUNCTIONAL NUTRITION LLC
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Dates
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Enumeration Date | 03/12/2026
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 3365 REGENT BLVD STE 130
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City | IRVING
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State | TX
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Zip | 75063-3127
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Country | US
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Telephone | 972-514-7956
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Fax | 972-366-7946
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Provider Business Mailing Address
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Address Line | 3365 REGENT BLVD STE 130
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City | IRVING
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State | TX
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Zip | 75063-3127
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Country | US
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Telephone | 972-514-7956
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Fax | 972-366-7946
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Authorized Official
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Title or Position | OWNER
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Name | NITI SHAH
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Credential |
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Telephone | 214-454-2278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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