Organization
NORTH TEXAS NUTRITION CONSULTANTS
Active
Organization
NORTH TEXAS NUTRITION CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN SHANE CLACK RD (PRESIDENT/REGISTERED DIETITIAN)
(817) 629-0420
Entity
Organization
Contact information
Practice address
106 AUSTIN AVE STE 107, WEATHERFORD, TX 76086-3381
(817) 629-0420
(817) 776-8150
Mailing address
805 TERRY TRL, WEATHERFORD, TX 76086-4601
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT82634
TX
Other
Enumeration date
04/19/2016
Last updated
05/26/2016
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