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General NPI Number Information
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NPI Number | 1629556899
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Entity Type | Organization
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Legal Business Name | JACKSON CLINIC OF CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 715 HILL COUNTRY DR STE 5
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City | KERRVILLE
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State | TX
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Zip | 78028-5965
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Country | US
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Telephone | 830-896-9633
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Fax | 830-896-9644
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Provider Business Mailing Address
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Address Line | 715 HILL COUNTRY DR STE 5
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City | KERRVILLE
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State | TX
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Zip | 78028-5965
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Country | US
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Telephone | 830-896-9633
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Fax | 830-896-9644
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROBIN MARIA JACKSON
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Credential |
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Telephone | 830-896-9633
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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 |
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License Number State |
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