Provider Demographics
NPI:1730901794
Name:GALIC, DANA (RD, LDN, MBA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:GALIC
Suffix:
Gender:F
Credentials:RD, LDN, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7561 W HORTENSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1807
Mailing Address - Country:US
Mailing Address - Phone:412-889-4359
Mailing Address - Fax:
Practice Address - Street 1:7561 W HORTENSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1807
Practice Address - Country:US
Practice Address - Phone:412-889-4359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered