NPIMap

Organization Active NPI

Maddox Nutrition LLC

  • Registered Dietitian
  • Boulder, CO
National Provider Identifier
1053179721
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
MADDOX NUTRITION LLC
Practice address
1942 Broadway Ste 314C
Boulder, CO 80302-5233
Phone
(719) 445-9573
NPI assigned
Mar 7, 2024
Last updated
Mar 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Liesel Maddox, RDNNPI 1225646839
Title
Registered Dietitian Nutritionist
Phone
(719) 445-9573

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

1942 Broadway Ste 314C
Boulder, CO 80302-5233

Mailing address

1942 Broadway Ste 314C
Boulder, CO 80302-5233
Phone (719) 445-9573

National Provider Directory

National Provider Directory

Locations

5900 Balcones Dr
#18252
Austin, TX 78731

5900 Balcones Dr
Ste 18252
Austin, TX 78731

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1053179721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1942 BROADWAY STE 314C",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803025233",
            "telephone_number": "719-445-9573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1942 BROADWAY STE 314C",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803025233",
            "telephone_number": "719-445-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADDOX NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "LIESEL",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN NUTRITIONIST",
        "authorized_official_telephone_number": "719-445-9573",
        "authorized_official_credential": "RDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.