Provider Demographics
NPI:1235256181
Name:DIMARCO NUTRITION IN ACTION
Entity Type:Organization
Organization Name:DIMARCO NUTRITION IN ACTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, CSP, CNSD
Authorized Official - Phone:630-361-3674
Mailing Address - Street 1:675 WINTERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9202
Mailing Address - Country:US
Mailing Address - Phone:630-361-3674
Mailing Address - Fax:630-357-8412
Practice Address - Street 1:675 WINTERGREEN CIR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9202
Practice Address - Country:US
Practice Address - Phone:630-361-3674
Practice Address - Fax:630-357-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001121133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211849Medicare ID - Type UnspecifiedMEDICARE PROVIDER