Provider Demographics
NPI:1972893873
Name:JACKSON CHIROPRACTIC PC
Entity type:Organization
Organization Name:JACKSON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-522-3433
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:IN
Mailing Address - Zip Code:46105-0344
Mailing Address - Country:US
Mailing Address - Phone:765-522-3433
Mailing Address - Fax:765-522-3352
Practice Address - Street 1:201 E US HIGHWAY 36
Practice Address - Street 2:PAT RADY WAY
Practice Address - City:BAINBRIDGE
Practice Address - State:IN
Practice Address - Zip Code:46105-9609
Practice Address - Country:US
Practice Address - Phone:765-522-3433
Practice Address - Fax:765-522-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty