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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