Provider Demographics
NPI:1073012290
Name:DRAEGER, JACKSON K (DC)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:K
Last Name:DRAEGER
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 1:827 CORMIER RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4706
Mailing Address - Country:US
Mailing Address - Phone:920-569-2350
Mailing Address - Fax:920-569-2333
Practice Address - Street 1:827 CORMIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4706
Practice Address - Country:US
Practice Address - Phone:920-569-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5321-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor