Provider Demographics
NPI:1093253833
Name:JACKSON, PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
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 1:630 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-2601
Mailing Address - Country:US
Mailing Address - Phone:336-475-8157
Mailing Address - Fax:
Practice Address - Street 1:630 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2601
Practice Address - Country:US
Practice Address - Phone:336-475-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor