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General NPI Number Information
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NPI Number | 1619854734
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Entity Type | Individual
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Provider Name | TODD JACKSON JR. DC
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Gender | Male
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 1131 BEL AIR ROAD UNIT 202
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City | BEL AIR
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State | MD
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Zip | 21014
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Country | US
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Telephone | 410-877-8077
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Fax |
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Provider Business Mailing Address
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Address Line | 506 LAFAYETTE AVE
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City | COLLINGDALE
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State | PA
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Zip | 19023-4107
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Country | US
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Telephone | 610-931-9035
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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 | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | S04265
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License Number State | MD
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