Healthcare Provider Details

I. General information

NPI: 1861227852
Provider Name (Legal Business Name): BLICK HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2024
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HIGHLANDS PLAZA DR APT 3002
SAINT LOUIS MO
63110-1334
US

IV. Provider business mailing address

5700 HIGHLANDS PLAZA DR APT 3002
SAINT LOUIS MO
63110-1334
US

V. Phone/Fax

Practice location:
  • Phone: 314-478-0055
  • Fax:
Mailing address:
  • Phone: 314-478-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER GIBBONS
Title or Position: COO
Credential:
Phone: 314-478-0055