Individual
DWAYNE CLACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CERTIFIED TRAINER
Contact information
Practice address
1629 K ST NW STE 300, WASHINGTON, DC 20006-1631
(202) 531-0195
Mailing address
5703 CYPRESS CREEK DR APT 3, HYATTSVILLE, MD 20782-1806
(202) 531-0195
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/13/2018
Last updated
11/10/2020
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