NPI Code Detail JSON Logo

1972830313 NPI number — BENJAMIN CALEB JACKSON D.C

NPI Number: 1972830313
Health Care Provider/Practitioner: BENJAMIN CALEB JACKSON D.C

Information about “1972830313” NPI (BENJAMIN CALEB JACKSON D.C) exists in 1972830313 in HTML format HTML  |  1972830313 in plain Text format TXT  |  1972830313 in PDF (Portable Document Format) PDF  |  1972830313 in an XML format XML  formats.

NPI Number : 1972830313 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972830313",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "BENJAMIN",
    "MiddleName": "CALEB",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "522 COLLEGE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TORRINGTON",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "82240-1517",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-532-2225",
    "MailingAddressFaxNumber": "307-534-2202",
    "FirstLinePracticeLocationAddress": "522 COLLEGE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TORRINGTON",
    "PracticeLocationAddressStateName": "WY",
    "PracticeLocationAddressPostalCode": "82240-1517",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "307-532-2225",
    "PracticeLocationAddressFaxNumber": "307-534-2202",
    "EnumerationDate": "11/05/2009",
    "LastUpdateDate": "04/08/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111N00000X",
        "TaxonomyName": "Chiropractor",
        "LicenseNumber": "1591",
        "LicenseNumberStateCode": "NE",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.