MEDICARE: NUTRITION DYNAMIX, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1006X	Metabolic Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1023565777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION DYNAMIX, LLC

Provider Business Mailing Address
First Line	:	825 DELAWARE AVE STE 200
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-6169
Country	:	US
Telephone Number	:	720-252-9415
Fax Number	:	720-302-0613

Provider Business Practice Location Address
First Line	:	825 DELAWARE AVE STE 200
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-6169
Country	:	US
Telephone Number	:	720-252-9415
Fax Number	:	720-302-0613

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA KARCH
Credential	:	RDN
Telephone Number	:	720-450-0376

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	03/19/2026

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