Provider Demographics
NPI:1386972495
Name:JAMISON, JACK D (D,C,)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:D
Last Name:JAMISON
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 WEST 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4159
Mailing Address - Country:US
Mailing Address - Phone:814-459-2225
Mailing Address - Fax:814-520-6709
Practice Address - Street 1:2220 WEST 8TH STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4159
Practice Address - Country:US
Practice Address - Phone:814-459-2225
Practice Address - Fax:814-520-6709
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor