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Individual
DR. JACK C. TIPS
Active
Individual
DR. JACK C. TIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., C.C.N.
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
0017161
NY
136A00000X
Registered Dietetic Technician
0017161
NY
Other
Enumeration date
04/04/2007
Last updated
10/16/2015
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