=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619602992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACEMEAL NUTRITION THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2022
-----------------------------------------------------
Last Update Date | 09/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 807 W HIGHWAY 50 STE 2
-----------------------------------------------------
City | O FALLON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62269-1856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-762-0687
-----------------------------------------------------
Fax | 833-536-1783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 ATALANTA AVE
-----------------------------------------------------
City | WEBSTER GROVES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63119-1949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTINE SINAK
-----------------------------------------------------
Credential | RD
-----------------------------------------------------
Telephone | 314-717-9109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------