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General NPI Number Information
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NPI Number | 1972424463
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Entity Type | Organization
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Legal Business Name | ELITE BODY DATA, LLC
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 222 S PROSPECT AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-4037
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Country | US
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Telephone | 872-203-1871
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Fax |
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Provider Business Mailing Address
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Address Line | 165 S WESTON AVE
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City | ELGIN
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State | IL
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Zip | 60123-6076
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Country | US
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Telephone | 872-203-1871
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Fax |
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Authorized Official
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Title or Position | OPERATOR
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Name | YAA BOAKYE
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Credential | MBA, RDN, LDN, CPT
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Telephone | 872-203-1871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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