MEDICARE: DR. STEVEN HOWARD JACKSON 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	111N00000X	Chiropractor	2335	NC

General Provider Information

NPI Number	:	1407803950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN HOWARD JACKSON D.C.

Provider Business Mailing Address
First Line	:	1422 ORCHARD LAKE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1474
Country	:	US
Telephone Number	:	704-844-9560
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 ORCHARD LAKE DR
Second Line	:	SUITE B
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1474
Country	:	US
Telephone Number	:	704-844-9560
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	04/04/2016

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