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General NPI Number Information
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NPI Number | 1811353311
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Entity Type | Organization
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Legal Business Name | TOTAL NUTRITION SOLUTIONS INC
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 2262 119TH PL
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City | BLUE ISLAND
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State | IL
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Zip | 60406-1123
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Country | US
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Telephone | 708-385-0882
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Fax |
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Provider Business Mailing Address
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Address Line | 2262 WEST 119TH PL
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City | BLUE ISLAND
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State | IL
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Zip | 60406-1123
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Country | US
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Telephone | 708-385-0882
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. SANDRA MARIE PHILLIPS
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Credential |
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Telephone | 630-865-2529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 164003956
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License Number State | IL
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