Provider Demographics
NPI:1053151472
Name:SPORTFUEL, INC.
Entity type:Organization
Organization Name:SPORTFUEL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & LEAD CLINICAL DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CCN
Authorized Official - Phone:708-246-9774
Mailing Address - Street 1:6688 JOLIET RD STE 193
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4575
Mailing Address - Country:US
Mailing Address - Phone:708-246-9774
Mailing Address - Fax:
Practice Address - Street 1:12 SALT CREEK LN STE 300
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8611
Practice Address - Country:US
Practice Address - Phone:708-246-9774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty