Provider Demographics
NPI:1174118681
Name:CHRISTINE DYAN INTERNATIONAL, LLC
Entity type:Organization
Organization Name:CHRISTINE DYAN INTERNATIONAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:DYAN
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:708-966-9342
Mailing Address - Street 1:9750 CRESCENT PARK CIR UNIT 255
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7503
Mailing Address - Country:US
Mailing Address - Phone:708-966-9352
Mailing Address - Fax:
Practice Address - Street 1:9750 CRESCENT PARK CIR UNIT 255
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-7503
Practice Address - Country:US
Practice Address - Phone:800-209-5139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty