Healthcare Provider Details

I. General information

NPI: 1902875446
Provider Name (Legal Business Name): JOHN S. JACKO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1977 MARKET SQUARE BLVD
WAYNESBORO PA
17268-3811
US

IV. Provider business mailing address

1977 MARKET SQUARE BLVD
WAYNESBORO PA
17268-3811
US

V. Phone/Fax

Practice location:
  • Phone: 717-762-6300
  • Fax: 717-762-1831
Mailing address:
  • Phone: 717-762-6300
  • Fax: 717-762-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC003848L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: