Provider Demographics
NPI:1699896100
Name:JACKSON, BRICE SPRINGER (DC)
Entity type:Individual
Prefix:DR
First Name:BRICE
Middle Name:SPRINGER
Last Name:JACKSON
Suffix:
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 1:375 FOUR LEAF LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6905
Mailing Address - Country:US
Mailing Address - Phone:434-823-2199
Mailing Address - Fax:
Practice Address - Street 1:375 FOUR LEAF LN
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6905
Practice Address - Country:US
Practice Address - Phone:434-823-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556630111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology