Provider Demographics
NPI:1013385665
Name:CHELNICK, ROBERT (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CHELNICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SHERMAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5012
Mailing Address - Country:US
Mailing Address - Phone:773-842-9820
Mailing Address - Fax:262-554-7475
Practice Address - Street 1:1601 SHERMAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5012
Practice Address - Country:US
Practice Address - Phone:773-842-9820
Practice Address - Fax:262-554-7475
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004081133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist