Individual
DR. JACK C. TIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., C.C.N.
Contact information
Practice address
9419 WESTMINSTER GLEN, AUSTIN, TX 78730
(512) 328-3996
(512) 263-7787
Mailing address
9419 PRINCE WILLIAM, AUSTIN, TX 78730
(512) 328-3996
(512) 263-7787
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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