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General NPI Number Information
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NPI Number | 1184447005
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Entity Type | Individual
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Provider Name | JARED KENTON JACKSON DC
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Gender | Male
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1593 GALBRAITH AVE SE STE 205
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-9032
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Country | US
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Telephone | 616-949-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 7385 30TH ST SE
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City | ADA
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State | MI
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Zip | 49301-8570
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Country | US
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Telephone | 231-640-4010
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301401582
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License Number State | MI
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