MEDICARE: THE DIETITIAN RX

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1487507430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DIETITIAN RX

Provider Business Mailing Address
First Line	:	4631 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2007
Country	:	US
Telephone Number	:	773-231-8130
Fax Number	:

Provider Business Practice Location Address
First Line	:	4631 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2007
Country	:	US
Telephone Number	:	773-231-8130
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMILY MARTIN
Credential	:	RD
Telephone Number	:	773-231-8130

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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Directions to “THE DIETITIAN RX ” Practice Location

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