Doctor Name: | COREY COLSON |
NPI Number: | 1518328574 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 164006771 |
Business Practice Address: | 1118 W Legacy Pointe Dr Springfield, IL - 627116444 |
Business Phone Number: | 2177878870 |
Business Fax Number: | |
Mailing Address: | 1118 W Legacy Pointe Dr, SPRINGFIELD |
State: | IL |
Postal Code: | 627116444 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/17/2016 |
NPI Last Update Date: | 03/17/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 164006771 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |