Organization
CLACK NUTRITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN SHANE CLACK MS, RD, LD (OWNER)
(817) 629-0420
Entity
Organization
Contact information
Practice address
1011 N MAIN ST, WEATHERFORD, TX 76086-2029
(817) 620-0420
Mailing address
805 TERRY TRL, WEATHERFORD, TX 76086-4601
(817) 629-0420
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
08/15/2013
Last updated
09/26/2013
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