Provider Demographics
NPI:1093572026
Name:JACKSON, TERRANCE MARQUE (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:MARQUE
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 1:3900 COMMERCE ST APT 617
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-2011
Mailing Address - Country:US
Mailing Address - Phone:210-788-6713
Mailing Address - Fax:
Practice Address - Street 1:1035 N HIGHWAY 77 STE 300
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1397
Practice Address - Country:US
Practice Address - Phone:972-366-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor