Provider Demographics
NPI:1528319316
Name:LIVE YOUR BEST YOU 365, INC
Entity type:Organization
Organization Name:LIVE YOUR BEST YOU 365, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RDN, LDN
Authorized Official - Phone:847-748-8477
Mailing Address - Street 1:770 CASTLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3971
Mailing Address - Country:US
Mailing Address - Phone:773-951-5557
Mailing Address - Fax:
Practice Address - Street 1:1020 MILWAUKEE AVE
Practice Address - Street 2:341
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3513
Practice Address - Country:US
Practice Address - Phone:847-478-8477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164004502OtherSTATE LICENSURE
IL164004502OtherSTATE LICENSURE