{"npi":"1275958118","type":"NPI-2","status":"active","name":{"display":"Nutrition Balance LLC","other":[],"organization_name":"NUTRITION BALANCE LLC","authorised_official":"Susanne Consiglio"},"specialty":{"primary_taxonomy":"261Q00000X","primary_taxonomy_description":"Clinic/Center","slug":"clinic-center","schema_org_specialty":null,"all":[{"code":"261Q00000X","description":"Clinic/Center","primary":true,"state":"MI","license":"00595403"}]},"addresses":[{"purpose":"LOCATION","street_1":"22811 GREATER MACK AVE","city":"SAINT CLAIR SHORES","state":"MI","postal_code":"480802021","country_code":"US","street_2":"SUITE 105","phone":"5867784877","fax":"5867783004"},{"purpose":"MAILING","street_1":"22811 GREATER MACK AVE","city":"SAINT CLAIR SHORES","state":"MI","postal_code":"480802021","country_code":"US","street_2":"SUITE 105","phone":"5867784877","fax":"5867783004"}],"license":{"state":"MI","number":"00595403"},"identifiers":[],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20140317002063","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"MI","pac_id":"8527299411"}]},"enumeration_date":"2014-03-01","last_updated":"2014-03-01","_meta":{"source":"NPPES","snapshot_date":"2014-03-01","doc_url":"https://findmynpi.com/api"}}