Provider Demographics
NPI:1588298699
Name:SPECIALTY INTEGRATIVE NUTRITION, LLC
Entity type:Organization
Organization Name:SPECIALTY INTEGRATIVE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:MLNARIK
Authorized Official - Suffix:
Authorized Official - Credentials:LDN
Authorized Official - Phone:773-234-7397
Mailing Address - Street 1:939 W NORTH AVE STE 650
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-1231
Mailing Address - Country:US
Mailing Address - Phone:773-234-7397
Mailing Address - Fax:
Practice Address - Street 1:939 W NORTH AVE STE 650
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-1231
Practice Address - Country:US
Practice Address - Phone:773-377-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty