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General NPI Number Information
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NPI Number | 1013892496
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Entity Type | Individual
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Provider Name | JACKSON JAEGER DPT
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Gender | Male
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 107 S 11TH ST STE 1
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City | MANCHESTER
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State | IA
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Zip | 52057-2245
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Country | US
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Telephone | 563-927-1499
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Fax | 563-927-1499
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Provider Business Mailing Address
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Address Line | 3365 DAVID DR
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City | DUBUQUE
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State | IA
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Zip | 52002-2906
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Country | US
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Telephone | 563-580-2969
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 131219
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License Number State | IA
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