MEDICARE: DR. DARRYL I JACKSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	17204	CA

General Provider Information

NPI Number	:	1780869479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRYL I JACKSON D.C.

Provider Business Mailing Address
First Line	:	6121 SUTTER AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-5301
Country	:	US
Telephone Number	:	510-418-7388
Fax Number	:	510-528-2566

Provider Business Practice Location Address
First Line	:	6121 SUTTER AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-5301
Country	:	US
Telephone Number	:	510-418-7388
Fax Number	:	510-528-2566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2008
Last Update Date	:	01/01/2008

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