NPIMap

Organization Active NPI

Fitness Formula, LTD

Doing business as FormuLifeRX

  • Registered Dietitian
  • Chicago, IL
National Provider Identifier
1033596440
Registry record updated May 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
FITNESS FORMULA, LTD
Doing business as
FormuLifeRX
Practice address
619 W Jackson Blvd
Chicago, IL 60661-5606
Phone
(312) 648-4666
Fax
(312) 648-0155
NPI assigned
May 5, 2015
Last updated
May 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian Singleton
Title
Cfo
Phone
(312) 648-4666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X NU Primary

Addresses

Primary practice location

619 W Jackson Blvd
Chicago, IL 60661-5606

Mailing address

619 W Jackson Blvd
Chicago, IL 60661-5606
Phone (312) 648-4666

Other names 1

  • FormuLifeRX Doing business as

National Provider Directory

National Provider Directory

Locations

1030 N Clark St
#600
Chicago, IL 60610
Phone (312) 944-1030

1235 N La Salle Dr
Chicago, IL 60610
Phone (312) 640-1235

3228 N Halsted St
Chicago, IL 60657
Phone (773) 755-3232

444 W Jackson Blvd
Chicago, IL 60606
Phone (312) 407-0143

619 W Jackson Blvd
Chicago, IL 60661
Phone (312) 627-0444

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1033596440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 W JACKSON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606615606",
            "telephone_number": "312-648-4666",
            "fax_number": "312-648-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 W JACKSON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606615606",
            "telephone_number": "312-648-4666",
            "fax_number": "312-648-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FITNESS FORMULA, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-05",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "SINGLETON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "312-648-4666"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FormuLifeRX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.