Exercising Nutritionally, LLC

Primary specialty

Research Clinic/CenterTaxonomy code 261QR1100X

Legal business name

EXERCISING NUTRITIONALLY, LLC

Practice address

4225 Naperville Rd
Enllc Located Within Lifestart Fitness Center
Lisle, IL 60532-3656

Phone

(630) 303-3686

NPI assigned

Jun 15, 2013

Last updated

Jun 15, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Craig E Broeder, PH.D. FACSM, FNAASO

Title

Ceo/Founder

Phone

(630) 303-3686

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1371254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371254400000",
    "number": "1629417357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1943 PHAETON CT",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605652410",
            "telephone_number": "630-303-3686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 NAPERVILLE RD",
            "address_2": "ENLLC LOCATED WITHIN LIFESTART FITNESS CENTER",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323656",
            "telephone_number": "630-303-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXERCISING NUTRITIONALLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-15",
        "last_updated": "2013-06-15",
        "status": "A",
        "authorized_official_last_name": "BROEDER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "630-303-3686",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D. FACSM, FNAASO"
    },
    "taxonomies": [
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Research Clinic/Center in Lisle, IL
• Providers in Lisle, IL by specialty
• Research Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2013; 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.