Provider Demographics
NPI:1689340887
Name:BACK IN BALANCE NUTRITION LLC
Entity type:Organization
Organization Name:BACK IN BALANCE NUTRITION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:865-748-8036
Mailing Address - Street 1:801 W BAY DR STE 236
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3269
Mailing Address - Country:US
Mailing Address - Phone:727-300-9316
Mailing Address - Fax:727-261-0208
Practice Address - Street 1:801 W BAY DR STE 236
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3269
Practice Address - Country:US
Practice Address - Phone:865-748-8036
Practice Address - Fax:727-261-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty