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General NPI Number Information
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NPI Number | 1760116693
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Entity Type | Organization
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Legal Business Name | INTUITIVE BALANCE NUTRITION, PLLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 77 W WASHINGTON ST STE 1620
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City | CHICAGO
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State | IL
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Zip | 60602-3218
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Country | US
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Telephone | 847-721-8030
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Fax | 312-641-6214
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Provider Business Mailing Address
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Address Line | 77 W WASHINGTON ST STE 1620
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City | CHICAGO
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State | IL
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Zip | 60602-3218
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Country | US
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Telephone | 847-721-8030
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Fax | 312-641-6214
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Authorized Official
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Title or Position | MEMBER
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Name | ALLISON B SHUDNOW
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Credential | MS, RDN, LDN, CEDS-S
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Telephone | 847-721-8030
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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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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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