Healthcare Provider Details

I. General information

NPI: 1548604200
Provider Name (Legal Business Name): FRANK KENNETH JACKSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S COWLEY ST STE 224
SPOKANE WA
99202-1330
US

IV. Provider business mailing address

PO BOX 469
SPOKANE WA
99210-0469
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-6706
  • Fax: 509-473-6704
Mailing address:
  • Phone: 509-473-6706
  • Fax: 509-473-6704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOP60742174
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: