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Organization
LIVE YOUR BEST YOU 365, INC
Active
Organization
LIVE YOUR BEST YOU 365, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISA BLOOM MPH, RDN, LDN (SOLE PROPRIETOR)
(847) 748-8477
Entity
Organization
Contact information
Practice address
1020 MILWAUKEE AVE, 341, DEERFIELD, IL 60015-3513
(847) 478-8477
Mailing address
770 CASTLEWOOD LN, DEERFIELD, IL 60015-3971
(773) 951-5557
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164004502
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164004502
STATE LICENSURE
IL
Enumeration date
09/20/2012
Last updated
03/11/2016
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