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General NPI Number Information
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NPI Number | 1235881814
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Entity Type | Organization
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Legal Business Name | MARILYN JACKSON LLC
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 10 SOUTH ST STE 205
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City | RIDGEFIELD
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State | CT
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Zip | 06877-4125
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Country | US
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Telephone | 203-212-9284
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SOUTH ST STE 205
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City | RIDGEFIELD
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State | CT
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Zip | 06877-4125
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Country | US
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Telephone | 203-212-9284
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Fax |
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Authorized Official
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Title or Position | OWNER, ACUPUNCTURIST
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Name | MARILYN JACKSON
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Credential | L.AC.
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Telephone | 203-212-9284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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