Provider Demographics
NPI:1932709524
Name:THE NUTRITION CLINIC LLC
Entity type:Organization
Organization Name:THE NUTRITION CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:785-236-9607
Mailing Address - Street 1:2213 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7609
Mailing Address - Country:US
Mailing Address - Phone:785-236-9607
Mailing Address - Fax:
Practice Address - Street 1:1331 LARAMIE ST STE 110
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4065
Practice Address - Country:US
Practice Address - Phone:785-560-2566
Practice Address - Fax:785-576-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-01
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center