MEDICARE: DR. STEVEN BRUCE JACKSON D.C, D.A.B.C.O

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	111NX0800X	Orthopedic Chiropractor	1788	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285722512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN BRUCE JACKSON D.C, D.A.B.C.O

Provider Business Mailing Address
First Line	:	3508 RICE ST
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-5002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 RICE ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55126-3170
Country	:	US
Telephone Number	:	651-483-4321
Fax Number	:	651-483-3440

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	10/15/2011

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