Provider Demographics
NPI:1619854734
Name:JACKSON, TODD JR (DC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-4107
Mailing Address - Country:US
Mailing Address - Phone:610-931-9035
Mailing Address - Fax:
Practice Address - Street 1:1131 BEL AIR ROAD
Practice Address - Street 2:UNIT 202
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-877-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04265111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation