Organization
FITNESS FORMULA, LTD
Active
Other names
FormuLifeRX
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN SINGLETON (CFO)
(312) 648-4666
Entity
Organization
Contact information
Practice address
619 W JACKSON BLVD, CHICAGO, IL 60661-5606
(312) 648-4666
(312) 648-0155
Mailing address
619 W JACKSON BLVD, CHICAGO, IL 60661-5606
(312) 648-4666
(312) 648-0155
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
05/05/2015
Last updated
05/05/2015
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