Healthcare Provider Details

I. General information

NPI: 1134042369
Provider Name (Legal Business Name): TIDAL NUTRITION AND RECOVERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W WELLINGTON AVE APT 1I
CHICAGO IL
60657-5401
US

IV. Provider business mailing address

520 W WELLINGTON AVE APT 1I
CHICAGO IL
60657-5401
US

V. Phone/Fax

Practice location:
  • Phone: 224-285-7029
  • Fax:
Mailing address:
  • Phone: 224-285-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY JARGER
Title or Position: OWNER
Credential: MBA, RDN, LDN
Phone: 224-374-2297