Provider Demographics
NPI:1154345007
Name:JACKSON, ALANA (CHIROPRACTER)
Entity type:Individual
Prefix:DR
First Name:ALANA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CHIROPRACTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22698
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86439-2698
Mailing Address - Country:US
Mailing Address - Phone:928-753-9225
Mailing Address - Fax:
Practice Address - Street 1:1708 EL CAZADOR
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7955
Practice Address - Country:US
Practice Address - Phone:928-753-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00100146OtherRAILROAD MEDICARE
AZAZ0155410OtherBLUE CROSSS BLUE SHIELD
AZ786080OtherAHCCCS
AZAZ0155410OtherBLUE CROSSS BLUE SHIELD
AZU91623Medicare UPIN