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General NPI Number Information
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NPI Number | 1427259191
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Entity Type | Individual
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Provider Name | TODD EDWARD JACKMAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 7373 FRANCE AVE S STE 408
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City | EDINA
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State | MN
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Zip | 55435-4549
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Country | US
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Telephone | 651-430-3800
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Fax | 651-430-3827
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Provider Business Mailing Address
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Address Line | 1950 NORTHWESTERN AVE S STE 102
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City | STILLWATER
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State | MN
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Zip | 55082-7615
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Country | US
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Telephone | 651-430-3800
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Fax | 651-430-3827
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 47215
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | MD00049377
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License Number State | WA
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