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NPI Code Detail

MEDICARE: DR. GILBERT JOSEPH JACKSON D.C.

MEDICARE:  DR. GILBERT JOSEPH 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
1111N00000XChiropractor19166CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DC0191660OTHERCAPTAN#

General Provider Information

NPI Number : 1649350620
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GILBERT JOSEPH JACKSON D.C.
Provider Business Mailing Address
First Line : 3249 MT. DIABLO COURT
Second Line : SUITE 102
City : LAFAYETTTE
State : CA
Zip : 94549-4050
Country : US
Telephone Number : 925-952-4222
Fax Number : 925-952-4212
Provider Business Practice Location Address
First Line : 3249 MT DIABLO CT
Second Line : SUITE 102
City : LAFAYETTE
State : CA
Zip : 94549-4084
Country : US
Telephone Number : 925-952-4222
Fax Number : 925-592-4212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 07/11/2014

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Directions to “ DR. GILBERT JOSEPH JACKSON D.C.” Practice Location

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