Provider Demographics
NPI:1154719490
Name:BALANCED BODIES BALANCED MINDS LLC
Entity type:Organization
Organization Name:BALANCED BODIES BALANCED MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:NACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LDN
Authorized Official - Phone:410-303-3511
Mailing Address - Street 1:4743 HALLOWED STRM
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7902
Mailing Address - Country:US
Mailing Address - Phone:410-303-3511
Mailing Address - Fax:
Practice Address - Street 1:4743 HALLOWED STRM
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7902
Practice Address - Country:US
Practice Address - Phone:410-303-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3720133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty