Provider Demographics
NPI:1215545355
Name:DALTON, RACHEL BARBARA (RD, LD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:BARBARA
Last Name:DALTON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N FAIRBANKS CT STE 7-121
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3013
Mailing Address - Country:US
Mailing Address - Phone:312-926-7437
Mailing Address - Fax:312-926-4346
Practice Address - Street 1:710 N FAIRBANKS CT STE 7-121
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3013
Practice Address - Country:US
Practice Address - Phone:312-926-7437
Practice Address - Fax:312-926-4346
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008021133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered