MEDICARE: DR. BYRON JACKSON I D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	DC.4408	OH

General Provider Information

NPI Number	:	1205133030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYRON JACKSON I D.C.

Provider Business Mailing Address
First Line	:	PO BOX 201852
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-8114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6009 LANDERHAVEN DR
Second Line	:	C2
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4192
Country	:	US
Telephone Number	:	770-714-1157
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	11/03/2025

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