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General NPI Number Information
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NPI Number | 1487055000
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Entity Type | Organization
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Legal Business Name | JACKSON CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 1043 BROWNSVILLE RD
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City | MORGANTOWN
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State | KY
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Zip | 42261-7011
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Country | US
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Telephone | 270-999-5708
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Fax |
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Provider Business Mailing Address
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Address Line | 1043 BROWNSVILLE RD
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City | MORGANTOWN
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State | KY
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Zip | 42261-7011
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Country | US
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Telephone | 270-999-5708
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH RYAN JACKSON
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Credential | D.C.
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Telephone | 270-999-5708
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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 | 5435
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License Number State | KY
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