NPIMap

Organization Active NPI

Living4Life Wellnessllc

  • Metabolic Nutrition Registered Dietitian
  • Detroit, MI
National Provider Identifier
1750771200
Registry record updated Feb 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X
License
812531 Issued in MI
Legal business name
LIVING4LIFE WELLNESSLLC
Practice address
11085 McKinney St
Detroit, MI 48224-1112
Phone
(313) 618-7454
NPI assigned
Feb 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2015

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

Authorized official

Name
Mr. Doniss L Hicks, RD
Title
President/Wellness Specialist
Phone
(313) 618-7454

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Metabolic Nutrition Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133VN1006X 812531 MI Primary

Addresses

Primary practice location

11085 McKinney St
Detroit, MI 48224-1112

Mailing address

PO Box 241603
Detroit, MI 48224-5603
Phone (313) 618-7454

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423008000000",
    "number": "1750771200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 241603",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482245603",
            "telephone_number": "313-618-7454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11085 MCKINNEY ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482241112",
            "telephone_number": "313-618-7454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING4LIFE WELLNESSLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "last_updated": "2015-02-04",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "DONISS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/WELLNESS SPECIALIST",
        "authorized_official_telephone_number": "313-618-7454",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "MI",
            "license": "812531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.